X-ray of distal radius fractures
Author:
Mikael Häggström [notes 1]
In projectional radiography ("X-ray") of a distal radius fracture, the most important findings are displacement and whether there is intra-articular involvement.
Contents
Quality checking
The radius should form the contour dorsally in order to better detect even undisplaced fractures.
Detection
Even if there's an initial obvious fracture, evaluate:
- Bone contours for disruptions
- Bone areas for unusual lines that are either hypoattenuating (in case of separation) or hyperattenuating (in case of compression)
In particular, also look at the scaphoid bone (see X-ray of scaphoid fractures)
In children
- Main article: X-ray of fractures in children
In patients with remaining growth plates, look for fracture involvement thereof (if present, see X-ray of fractures in children).
Displacement
Dorsal or volar tilt
The dorsal or volar tilt can be described by an angle from the axial plane of the radius, going between:[1]
- A line drawn between the distal ends of the articular surface of the radius.
- The axial plane of radius: Represented by a line that is perpendicular to the diaphysis of the radius.
Sometimes, the diaphysis of the radius is hard to distinguish from the ulna, and a line between them may be used instead.[2]
Although this is generally the definition of dorsal or volar tilt, an alternative measure is a comparison to normal anatomical position of the articular surface of radius (which normally has a volar tilt of 11° to 12°). This is preferable to use in fractures with a dorsal tilt of up to 11° from normal anatomical position.[notes 2]
Radial inclination
Radial inclination (also called radial angulation) is the angle measured between:[3][4]
- A line drawn between the distal ends of the articular surface of the radius on an AP view of the wrist.
- A line that is perpendicular to the diaphysis of the radius.
Radial inclination.[5]
Radial inclination is normally 21-25°.[6]
Other important measures
- Displacemen in other directions
- Comminuted fracture, particularly if it has intra-articular involvement
- Other skeletal fractures, commonly a loose ulnar styloid process.
Report
- If volar or dorsal tilt:
- The degree thereof
- That it is in comparison to the axial plane of radius (to avoid mixup with being in relation to the normal anatomical position)
- Other abnormal important features, if present
- See also: General notes on reporting
See also
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
- ↑ Using the axial plane of the radius in such cases would result in a "volar tilt", which is contrary to the actual disease mechanism.
References
- ↑ Piva Neto, Antonio; Lhamby, Fabio Colla (2011). "Fixação das fraturas da extremidade distal do rádio pela técnica de kapandji modificada: avaliação dos resultados radiológicos ". Revista Brasileira de Ortopedia 46 (4): 368–373. doi:. ISSN 0102-3616.
- ↑ Dr Paresh K Desai. Colles fracture. Radiopedia. Retrieved on 2016-12-18.
- ↑ Jack A Porrino, Jr (2015-10-20). Distal Radial Fracture Imaging. Medscape. Retrieved on 2016-12-18.
- ↑ Pankaj Kumar Mishra; Manoj Nagar; Suresh Chandra Gaur; Anuj Gupta (2016). "Morphometry of distal end radius in the Indian population: A radiological study ". Indian Journal of Orthopaedics 50 (6). Archived from the original. .
- ↑ 5.0 5.1 Beumer, Annechien; Adlercreutz, Catharina; Lindau, Tommy R (2013). "Early prognostic factors in distal radius fractures in a younger than osteoporotic age group: a multivariate analysis of trauma radiographs ". BMC Musculoskeletal Disorders 14 (1). doi:. ISSN 1471-2474.
- ↑ Page 783 in: Joshua Broder (2011). Diagnostic Imaging for the Emergency Physician . Elsevier Health Sciences. ISBN 9781437735871.
