Difference between revisions of "X-ray of distal radius fractures"

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===Radial inclination===
 
===Radial inclination===
[[File:Radial angulation.jpg|thumb|'''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>
 
#A line drawn between the distal ends of the articular surface of the radius on an AP view of the wrist.
 
#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.
 
#A line that is perpendicular to the diaphysis of the radius.
 +
<gallery>
 +
File:Radial angulation.jpg|'''Radial inclination'''.<ref name=Beumer2013/>
 +
</gallery>
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Radial inclination is normally 21-25°.<ref>[https://books.google.com/books?id=q3_EthzU3dcC&pg=PA783 Page 783] in: {{cite book|title=Diagnostic Imaging for the Emergency Physician|authors=Joshua Broder|publisher=Elsevier Health Sciences|year=2011|isbn=9781437735871}}</ref>
 
Radial inclination is normally 21-25°.<ref>[https://books.google.com/books?id=q3_EthzU3dcC&pg=PA783 Page 783] in: {{cite book|title=Diagnostic Imaging for the Emergency Physician|authors=Joshua Broder|publisher=Elsevier Health Sciences|year=2011|isbn=9781437735871}}</ref>
  
 
===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>]]
+
[[File:Ulnar variance.jpg|thumb|160px|'''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 16:10, 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.

Quality checking

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

Detection

edit
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

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.

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

  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.

References

  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.