Difference between revisions of "X-ray of distal radius fractures"
(Expanded) |
(→Displacement: Sometimes preferable) |
||
Line 20: | Line 20: | ||
===Dorsal or volar tilt=== | ===Dorsal or volar tilt=== | ||
[[File:Dorsal tilt.jpg|thumb|160px|Fracture with a dorsal tilt: Dorsal is left, and volar is right in the image.]] | [[File:Dorsal tilt.jpg|thumb|160px|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, | + | The dorsal or volar tilt can be described by an angle from the axial plane of the radius, going between:<ref name="Piva NetoLhamby2011">{{cite journal|last1=Piva Neto|first1=Antonio|last2=Lhamby|first2=Fabio Colla|title=Fixação das fraturas da extremidade distal do rádio pela técnica de kapandji modificada: avaliação dos resultados radiológicos|journal=Revista Brasileira de Ortopedia|volume=46|issue=4|year=2011|pages=368–373|issn=0102-3616|doi=10.1590/S0102-36162011000400004}}</ref> |
*A line drawn between the distal ends of the articular surface of the radius. | *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. | *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.<ref>{{cite web|url=https://radiopaedia.org/articles/colles-fracture|title=Colles fracture|author=Dr Paresh K Desai|accessdate=2016-12-18|website=Radiopedia}}</ref> | Sometimes, the diaphysis of the radius is hard to distinguish from the [[ulna]], and a line between them may be used instead.<ref>{{cite web|url=https://radiopaedia.org/articles/colles-fracture|title=Colles fracture|author=Dr Paresh K Desai|accessdate=2016-12-18|website=Radiopedia}}</ref> | ||
− | Although this is the | + | 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.<ref group="notes">Using the axial plane of the radius in such cases would result in a "volar tilt", which is contrary to the actual disease mechanism.</ref> |
− | === | + | ===Radial inclination=== |
− | + | [[File:Radial angulation.jpg|thumb|'''Radial inclination'''.<ref name=Beumer2013/>]] | |
− | |||
− | |||
− | File:Radial angulation.jpg|'''Radial inclination'''.<ref name=Beumer2013/> | ||
− | |||
Radial inclination (also called ''radial angulation'') is the angle measured between:<ref>{{cite web|url=http://emedicine.medscape.com/article/398406-overview|title=Distal Radial Fracture Imaging|author=Jack A Porrino, Jr|date=2015-10-20|accessdate=2016-12-18|website=[[Medscape]]}}</ref><ref>{{cite journal|url=http://www.ijoonline.com/article.asp?issn=0019-5413;year=2016;volume=50;issue=6;spage=610;epage=615;aulast=Mishra|title=Morphometry of distal end radius in the Indian population: A radiological study|author1=Pankaj Kumar Mishra |author2=Manoj Nagar |author3=Suresh Chandra Gaur |author4=Anuj Gupta |year=2016|volume=50|issue=6|journal=Indian Journal of Orthopaedics}}</ref> | Radial inclination (also called ''radial angulation'') is the angle measured between:<ref>{{cite web|url=http://emedicine.medscape.com/article/398406-overview|title=Distal Radial Fracture Imaging|author=Jack A Porrino, Jr|date=2015-10-20|accessdate=2016-12-18|website=[[Medscape]]}}</ref><ref>{{cite journal|url=http://www.ijoonline.com/article.asp?issn=0019-5413;year=2016;volume=50;issue=6;spage=610;epage=615;aulast=Mishra|title=Morphometry of distal end radius in the Indian population: A radiological study|author1=Pankaj Kumar Mishra |author2=Manoj Nagar |author3=Suresh Chandra Gaur |author4=Anuj Gupta |year=2016|volume=50|issue=6|journal=Indian Journal of Orthopaedics}}</ref> | ||
Line 40: | Line 36: | ||
===Other important measures=== | ===Other important measures=== | ||
+ | [[File:Ulnar variance.jpg|thumb|'''Ulnar variance''': Normally between -4 mm (ulna shorter than radius) and +2 mm (ulna longer than radius).<ref name=Beumer2013>{{cite journal|last1=Beumer|first1=Annechien|last2=Adlercreutz|first2=Catharina|last3=Lindau|first3=Tommy R|title=Early prognostic factors in distal radius fractures in a younger than osteoporotic age group: a multivariate analysis of trauma radiographs|journal=BMC Musculoskeletal Disorders|volume=14|issue=1|year=2013|issn=1471-2474|doi=10.1186/1471-2474-14-170}}</ref>]] | ||
*Displacemen in other directions | *Displacemen in other directions | ||
*Comminuted fracture, particularly if it has intra-articular involvement | *Comminuted fracture, particularly if it has intra-articular involvement |
Revision as of 16:09, 17 July 2019
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:[4][5]
- 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 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 is it 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.
- ↑ 3.0 3.1 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.
- ↑ 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. .
- ↑ Page 783 in: Joshua Broder (2011). Diagnostic Imaging for the Emergency Physician . Elsevier Health Sciences. ISBN 9781437735871.