Gilula's lines are three smooth arcs that orthopedic surgeons and radiologists use to assess carpal alignment on a standard wrist X-ray (dorsovolar projection). Disruption of these lines can indicate a carpal dislocation or instability.
Understanding Gilula's Lines
The lines are imaginary arcs that connect specific points on the carpal bones, providing a visual guide to normal carpal relationships.
- Line 1: Follows the proximal convexities of the proximal carpal row (scaphoid, lunate, triquetrum).
- Line 2: Follows the distal convexities of the proximal carpal row.
- Line 3: Follows the proximal convexities of the distal carpal row (trapezium, trapezoid, capitate, hamate).
Clinical Significance
The primary clinical significance of Gilula's lines is to aid in the diagnosis of carpal instability or dislocations, particularly perilunate dislocations and scaphoid fractures that can disrupt carpal alignment. If any of these arcs are broken or disrupted, it suggests an underlying injury that needs further investigation. It’s a quick and helpful visual tool, but should always be used in conjunction with a thorough clinical examination and other imaging modalities if needed.
Example
Imagine a smooth, continuous rainbow shape formed by the three lines over the carpal bones on an X-ray. If a bone is out of place, the "rainbow" will be distorted, indicating a potential problem.
