Difference between revisions of "X-ray of distal radius fractures"
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In projectional radiography ("X-ray") of a distal radius fracture, the most important findings are displacement and whether there is intra-articular involvement. | 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== | ||
| + | {{Fracture detection on X-ray}} | ||
| + | |||
| + | In particular, also look at the scaphoid bone (see [[X-ray of scaphoid fractures|X-ray of scaphoid fractures]]) | ||
| + | |||
| + | {{X-ray of fractures in children}} | ||
==Displacement== | ==Displacement== | ||
| − | === | + | ===Dorsal or volar tilt=== |
| − | [[File:Dorsal tilt | + | [[File:Dorsal tilt.jpg|thumb|160px|Fracture with a dorsal tilt: Dorsal is left, and volar is right in the image.]] |
| − | The volar | + | The dorsal or volar tilt can be described by an angle from the axial plane of the radius, going between:<ref name="Piva NetoLhamby2011">{{cite journal|last1=Piva Neto|first1=Antonio|last2=Lhamby|first2=Fabio Colla|title=Fixação das fraturas da extremidade distal do rádio pela técnica de kapandji modificada: avaliação dos resultados radiológicos|journal=Revista Brasileira de Ortopedia|volume=46|issue=4|year=2011|pages=368–373|issn=0102-3616|doi=10.1590/S0102-36162011000400004}}</ref> |
*A line drawn between the distal ends of the articular surface of the radius. | *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 | + | Sometimes, the diaphysis of the radius is hard to distinguish from the [[ulna]], and a line between them may be used instead.<ref>{{cite web|url=https://radiopaedia.org/articles/colles-fracture|title=Colles fracture|author=Dr Paresh K Desai|accessdate=2016-12-18|website=Radiopedia}}</ref> |
| + | |||
| + | 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.<ref group="notes">Using the axial plane of the radius in such cases would result in a "volar tilt", which is contrary to the actual disease mechanism.</ref> | ||
| + | |||
| + | ===Radial inclination=== | ||
| + | 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 that is perpendicular to the diaphysis of the radius. | ||
| + | <gallery> | ||
| + | File:Radial angulation.jpg|'''Radial inclination'''.<ref name=Beumer2013/> | ||
| + | </gallery> | ||
| + | |||
| + | 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=== | ||
| + | [[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 | ||
| + | *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 it is 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 | ||
| + | <P>{{Reporting}} | ||
==See also== | ==See also== | ||
*[[X-ray of fractures]] | *[[X-ray of fractures]] | ||
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Latest revision as of 16:15, 20 August 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
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 it is 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.
