The best initial imaging for a suspected fractured hand is a three‑view radiographic series: PA (or AP), oblique, and lateral. The oblique view often best reveals fracture lines in metacarpals and phalanges, while the lateral view shows displacement and angulation. These complementary views ensure accurate detection, measurement, and treatment planning.

PA (posteroanterior) hand radiograph is taken with the palm flat on the detector and the X‑ray beam passing from the dorsal (back) to palmar surface. It’s the standard view—less magnification, better joint spacing and bone alignment. AP (anteroposterior) is taken with the palm facing the X‑ray tube (palm up); used when PA positioning isn’t possible but gives more magnification and distortion.

A routine hand X‑ray typically uses three views: posteroanterior (PA), oblique and lateral. These projections evaluate bone alignment, joint spaces and fractures. Additional or comparative views (for example focused projections or the opposite hand) may be requested for specific injuries, pediatric assessments or preoperative planning, as directed by the clinician.

Center the central ray perpendicular to the detector at the third metacarpophalangeal (MCP) joint for a PA hand. Position the palmar surface flat on the image receptor with fingers extended and slightly separated. Include from the fingertips through the distal radius and ulna, and collimate to encompass all soft tissues and bony margins. Immobilize as needed to avoid motion.

For a PA wrist radiograph, direct the central ray perpendicular to the midcarpal area (wrist joint), centered at the level of the distal radius and proximal carpal row. Aim roughly over the midcarpal space—just distal to the radial styloid—so the beam passes through the radiocarpal and intercarpal joints and the distal radius/ulna. Use appropriate collimation and immobilization.

Suspect a hand fracture if there’s acute pain, swelling, bruising, deformity, inability to grip, local bony tenderness, numbness or impaired circulation. Clinicians inspect, palpate, check neurovascular status and movement, then obtain plain X‑rays (AP, lateral, oblique). Use CT or MRI for complex, intra‑articular, or occult scaphoid injuries. Immobilize/splint and refer to orthopedics or emergency care for displaced, open, or neurovascularly compromised fractures.