Distal radius fracture CT

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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

CT may be useful and can give significant information in comparison with that obtained with conventional radiography in evaluation of complex or occult fractures, distal radial articular surface, distal radio-ulnar joint, ventro-medial fracture fragment assessments of fracture healing as well as post-surgical evaluation.

CT scan

• Although not routinely necessary for most patients with distal radius fracture, CT scan be helpful in developing a preoperative surgical plan for patients with complex, multifragmentary fractures.
• If CT scans are desired, they should be obtained after provisional closed reduction and immobilization to provide an accurate assessment of the displacement of fracture fragments, the articular incongruity, and the magnitude of comminution.
• CT may be indicated for the confirmation of occult fractures suspected on the basis of physical examination, when plain films are normal.
• Knowledge of the thickness of the CT slices can enable to estimate the dimensions and size of each fragment.
• A systematic review of sagittal reformatted CT slices can be beneficial for evaluating the intermediate column fragments and determining both the surgical approach and the type of fixation that may be required.
• Recent literature suggests that evaluating CT examination, imaging in axial and sagittal or axial and coronal planes with 2 mm contiguous sections is usually sufficient.
• CT scan based, the arc method of measurement, are used more reliably for quantifying articular surface incongruities of distal radius than plain radiographic measurements.

CT scan Wrist dorsal view. Source: Case courtesy by: Dr. Rohan A. Bhimani

CT scan lateral view with intraarticular step. Source: Case courtesy by: Dr. Rohan A. Bhimani

CT scan wrist ventral view. Source: Case courtesy by: Dr. Rohan A. Bhimani