Difference between revisions of "X-ray of distal radius fractures"
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===Radial inclination=== | ===Radial inclination=== | ||
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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.
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 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.
- ↑ 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.