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Plain radiography remains the imaging study of choice for most applications in the upper extremity. The upper extremity is divided into three sections: the shoulder, the elbow and forearm, and the wrist and hand. Similar to the shoulder, the most common use of elbow and forearm plain radiography is in the setting of acute trauma. As with the rest of the upper extremity, the major indication for imaging of the wrist and hand is in the setting of acute trauma. It is one of the most difficult areas to differentiate between soft tissue and skeletal injury on history and physical examination alone. Imaging is necessary even with obvious fractures because the extent of the fracture, displacement, angulation, and articular involvement are important to determine if the patient needs closed reduction in the ED or immediate orthopedic referral for possible open reduction and surgical fixation.
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