Distal radius fracture differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Distal radius fracture}}
{{Distal radius fracture}}
{{CMG}} {{AE}} {{VVS}}
{{CMG}}; {{AE}} {{Rohan}}
 
==Overview==
==Overview==
[[Distal radius fracture]] must be differentiated from [[wrist strain]], [[Ligamentous laxity|ligamentous]] carpal injury such as [[scapholunate]] ligament and [[triangular fibrocartilage]] complex (TFCC) tear.
==Differentiating Distal Radius Fracture from other Diseases==
* [[Distal radius fracture]] must be differentiated from other diseases that [[wrist pain]], [[restriction of movements]], and [[deformity]], such as [[wrist strain]], [[Ligamentous laxity|ligamentous]] carpal injury such as [[scapholunate ligament]] and [[triangular fibrocartilage]] complex (TFCC) tear.<ref name="pmid8423324">{{cite journal| author=Trumble TE, Benirschke SK, Vedder NB| title=Ipsilateral fractures of the scaphoid and radius. | journal=J Hand Surg Am | year= 1993 | volume= 18 | issue= 1 | pages= 8-14 | pmid=8423324 | doi=10.1016/0363-5023(93)90237-W | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8423324  }} </ref><ref name="pmid9726557">{{cite journal| author=Stoffelen D, De Mulder K, Broos P| title=The clinical importance of carpal instabilities following distal radial fractures. | journal=J Hand Surg Br | year= 1998 | volume= 23 | issue= 4 | pages= 512-6 | pmid=9726557 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9726557  }} </ref><ref name="pmid12457345">{{cite journal| author=May MM, Lawton JN, Blazar PE| title=Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. | journal=J Hand Surg Am | year= 2002 | volume= 27 | issue= 6 | pages= 965-71 | pmid=12457345 | doi=10.1053/jhsu.2002.36525 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12457345  }} </ref><ref name="pmid16039453">{{cite journal| author=Lindau T| title=Treatment of injuries to the ulnar side of the wrist occurring with distal radial fractures. | journal=Hand Clin | year= 2005 | volume= 21 | issue= 3 | pages= 417-25 | pmid=16039453 | doi=10.1016/j.hcl.2005.04.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16039453  }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="3" rowspan="2" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Restriction of Movements
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Deformity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Decreased Grip Strength
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Decreased sensation in course of Median nerve
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Distal radius fracture]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
* Distal fragment displacement
* Distal fragment angulation
* Radial shortening
| style="background: #F5F5F5; padding: 5px;" |
* Useful for preoperative surgical planning for patients with complex, multifragmentary fractures.
| style="background: #F5F5F5; padding: 5px;" |
* Useful in diagnosing occult [[Bone fracture|fractures]], [[Ligamentous laxity|ligamentous]] and [[soft tissue]] injuries
| style="background: #F5F5F5; padding: 5px;" |X-ray
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Wrist strain
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* No evidence of [[Bone fracture|fracture]] on radiographs
| style="background: #F5F5F5; padding: 5px;" |
* No evidence of [[Bone fracture|fracture]] on CT
| style="background: #F5F5F5; padding: 5px;" |
* [[Soft tissue]] swelling and tear may be seen
| style="background: #F5F5F5; padding: 5px;" |MRI
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ligamentous carpal injury
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* No evidence of [[Bone fracture|fracture]] on radiographs
| style="background: #F5F5F5; padding: 5px;" |
* No evidence of [[Bone fracture|fracture]] on CT
| style="background: #F5F5F5; padding: 5px;" |
* Swelling and tear of the [[ligament]] may be seen
| style="background: #F5F5F5; padding: 5px;" |MRI
| style="background: #F5F5F5; padding: 5px;" |
* Most common injury is [[scapholunate]] ligament tear with widening of the scapholunate interval.
* Positive Watson shift test.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Triangular fibrocartilage]] complex (TFCC) tear
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* No evidence of [[Bone fracture|fracture]] on radiographs
| style="background: #F5F5F5; padding: 5px;" |
* No evidence of [[Bone fracture|fracture]] on CT
| style="background: #F5F5F5; padding: 5px;" |
* Swelling and tear of the [[ligament]] may be seen
| style="background: #F5F5F5; padding: 5px;" |MRI
| style="background: #F5F5F5; padding: 5px;" |
* Wrist [[arthroscopy]] can be useful in visualizing and repairing [[TFCC tear]]
|}
==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Needs content]]
[[Category:Needs content]]
[[Category:Orthopedics]]
[[Category:Orthopedics]]
[[Category:Orthopedic surgery]]
[[Category:Orthopedic surgery]]
[[Category:Primary care]]
[[Category:Fractures]]
[[Category:Fractures]]
[[Category:Bone fractures]]

Latest revision as of 21:25, 29 July 2020

Distal radius fracture Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

Distal radius fracture must be differentiated from wrist strain, ligamentous carpal injury such as scapholunate ligament and triangular fibrocartilage complex (TFCC) tear.

Differentiating Distal Radius Fracture from other Diseases

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Imaging
Pain Restriction of Movements Deformity Tenderness Decreased Grip Strength Decreased sensation in course of Median nerve X-ray CT scan MRI
Distal radius fracture + + + + + +/-
  • Distal fragment displacement
  • Distal fragment angulation
  • Radial shortening
  • Useful for preoperative surgical planning for patients with complex, multifragmentary fractures.
 X-ray
Wrist strain + + - + - - MRI
Ligamentous carpal injury + + +/- + - -
  • Swelling and tear of the ligament may be seen
 MRI
  • Most common injury is scapholunate ligament tear with widening of the scapholunate interval.
  • Positive Watson shift test.
Triangular fibrocartilage complex (TFCC) tear + +/- - + - -
  • Swelling and tear of the ligament may be seen
 MRI

References

  1. ↑ Trumble TE, Benirschke SK, Vedder NB (1993). "Ipsilateral fractures of the scaphoid and radius". J Hand Surg Am. 18 (1): 8–14. doi:10.1016/0363-5023(93)90237-W. PMID 8423324.
  2. ↑ Stoffelen D, De Mulder K, Broos P (1998). "The clinical importance of carpal instabilities following distal radial fractures". J Hand Surg Br. 23 (4): 512–6. PMID 9726557.
  3. ↑ May MM, Lawton JN, Blazar PE (2002). "Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability". J Hand Surg Am. 27 (6): 965–71. doi:10.1053/jhsu.2002.36525. PMID 12457345.
  4. ↑ Lindau T (2005). "Treatment of injuries to the ulnar side of the wrist occurring with distal radial fractures". Hand Clin. 21 (3): 417–25. doi:10.1016/j.hcl.2005.04.002. PMID 16039453.

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