Distal radius fracture x ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]

X Ray

Diagnosis may be evident clinically when the distal radius is deformed but should be confirmed by x-ray. X-ray of the affected wrist is required if a fracture is suspected. CT scan is often performed to investigate the exact anatomy of the fracture, especially if surgery is considered. Investigation of a potential distal radial fracture includes assessment of the lateral articular angle, radial length, and articular surface.

Lateral Articular Angle

The lateral articular angle is the angle between the axis of the radius and the articular cup. This angle is measured on x-ray films. Normally, the angle is turned down toward the thumb (volar tilt) by 11°. As pressure is applied to the radius, the cup may become aligned differently. Alignment up to 0° is still considered to be functional, and does not require any intervention. However, tilt away from the thumb (dorsal tilt) beyond this point (>11° deviation) requires reduction of the fracture. When dorsal tilt beyond the acceptable threshold occurs, distal radio-ulnar joint motion is altered, and forearm rotation becomes restricted. The upper limit of an acceptable deformity after reduction of the fracture is 5° of dorsal tilt.

Radial Length

Radial length is one of the important considerations in a distal radius fracture. The core question that must be answered is "is it short?" The radius length would be too short if there is greater than neutral variance, especially when compared to the opposite side of the body. If the radial length remains uncorrected, ulnar impaction syndrome may occur.

Articular Surface

Any articular joint surface must be smooth for it to function properly. The surface is not smooth if there is more than 1 mm step deformity, and is associated with posttraumatic arthrosis. Irregularity may result in radiocarpal arthritis, pain, and stiffness. If the surface is very irregular, the optimal treatment is fusion.