X-ray of distal radius fractures

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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.

Quality checking

The radius should form the contour dorsally in order to better detect even undisplaced fractures.


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).


Dorsal or volar tilt

Fracture with a dorsal tilt: Dorsal is left, and volar is right in the image.

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]

  1. A line drawn between the distal ends of the articular surface of the radius on an AP view of the wrist.
  2. A line that is perpendicular to the diaphysis of the radius.

Radial inclination is normally 21-25°.[6]

Other important measures

Ulnar variance: Normally between -4 mm (ulna shorter than radius) and +2 mm (ulna longer than radius).[5]
  • Displacemen in other directions
  • Comminuted fracture, particularly if it has intra-articular involvement
  • Other skeletal fractures, commonly a loose ulnar styloid process.


  • 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


  1. 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.
  2. Using the axial plane of the radius in such cases would result in a "volar tilt", which is contrary to the actual disease mechanism.


  1. 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:10.1590/S0102-36162011000400004. ISSN 0102-3616. 
  2. Dr Paresh K Desai. Colles fracture. Radiopedia. Retrieved on 2016-12-18.
  3. Jack A Porrino, Jr (2015-10-20). Distal Radial Fracture Imaging. Medscape. Retrieved on 2016-12-18.
  4. 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. 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:10.1186/1471-2474-14-170. ISSN 1471-2474. 
  6. Page 783 in: Joshua Broder (2011). Diagnostic Imaging for the Emergency Physician . Elsevier Health Sciences. ISBN 9781437735871.