Distal radius fracture x ray: Difference between revisions

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__NOTOC__
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{{Distal radius fracture}}
{{Distal radius fracture}}
{{CMG}} {{AE}} {{VVS}}
{{CMG}}; {{AE}} {{Rohan}}
 
==Overview==
 
[[Radiography|Radiographic]] imaging is important in diagnosis, classification, treatment and follow-up assessment of [[Distal radius fracture|distal radius fractures]]. The routine minimal evaluation for [[distal radius fracture]]<nowiki/>s must include two views - a postero-anterior (PA) view and lateral view.
==X Ray==
==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''.
*[[Radiography|Radiographic]] imaging is important in diagnosis, classification, treatment and follow-up assessment of [[Distal radius fracture|distal radius fractures]].<ref name="pmid8479720">{{cite journal| author=Metz VM, Gilula LA| title=Imaging techniques for distal radius fractures and related injuries. | journal=Orthop Clin North Am | year= 1993 | volume= 24 | issue= 2 | pages= 217-28 | pmid=8479720 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8479720  }} </ref><ref name="pmid18762124">{{cite journal| author=Henry MH| title=Distal radius fractures: current concepts. | journal=J Hand Surg Am | year= 2008 | volume= 33 | issue= 7 | pages= 1215-27 | pmid=18762124 | doi=10.1016/j.jhsa.2008.07.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18762124  }} </ref><ref name="pmid16039439">{{cite journal| author=Medoff RJ| title=Essential radiographic evaluation for distal radius fractures. | journal=Hand Clin | year= 2005 | volume= 21 | issue= 3 | pages= 279-88 | pmid=16039439 | doi=10.1016/j.hcl.2005.02.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16039439  }} </ref><ref name="pmid16039440">{{cite journal| author=Slutsky DJ| title=Predicting the outcome of distal radius fractures. | journal=Hand Clin | year= 2005 | volume= 21 | issue= 3 | pages= 289-94 | pmid=16039440 | doi=10.1016/j.hcl.2005.03.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16039440  }} </ref><ref name="pmid12679687">{{cite journal| author=Lill CA, Goldhahn J, Albrecht A, Eckstein F, Gatzka C, Schneider E| title=Impact of bone density on distal radius fracture patterns and comparison between five different fracture classifications. | journal=J Orthop Trauma | year= 2003 | volume= 17 | issue= 4 | pages= 271-8 | pmid=12679687 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12679687  }} </ref><ref name="pmid15576227">{{cite journal| author=Nesbitt KS, Failla JM, Les C| title=Assessment of instability factors in adult distal radius fractures. | journal=J Hand Surg Am | year= 2004 | volume= 29 | issue= 6 | pages= 1128-38 | pmid=15576227 | doi=10.1016/j.jhsa.2004.06.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15576227  }} </ref><ref name="pmid22036131">{{cite journal| author=Fujitani R, Omokawa S, Akahane M, Iida A, Ono H, Tanaka Y| title=Predictors of distal radioulnar joint instability in distal radius fractures. | journal=J Hand Surg Am | year= 2011 | volume= 36 | issue= 12 | pages= 1919-25 | pmid=22036131 | doi=10.1016/j.jhsa.2011.09.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22036131  }} </ref>
*The routine minimal evaluation for [[Distal radius fracture|distal radius fractures]] must include two views - a postero-anterior (PA) view and lateral view.
*'''Positioning for the x-rays''':
**The posteroanterior view should be acquired with the patient’s [[elbow]] and [[shoulder]] at 90° and the [[forearm]] in neutral rotation.
**When the lateral view is acquired correctly, i.e., in the absence of relative [[pronation]] or [[supination]], the [[Pisiform bone|pisiform]] bone should be superimposed on the distal pole of the [[Scaphoid bone|scaphoid]].


===Lateral Articular Angle===
===Posteroanterior View Inspection===
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===
Radial length is one of the important considerations in a distal radius fracture.
*It is used when assessing shortening of the [[radius]] after [[Bone fracture|fracture]], can be obtained using the posteroanterior view.
The core question that must be answered is "is it short?"
*'''Method''':
The radius length would be too short if there is greater than neutral variance, especially when compared to the opposite side of the body.
**Two lines are drawn perpendicular to the long axis of the [[radius]], one at the tip of the [[Radial styloid process|radial styloid]] and the second at the ulnar border of the [[distal radial articular surface]].
If the radial length remains uncorrected, [[ulnar impaction syndrome]] may occur.
**Normally, this length is about 12 mm.
**Excessive radial [[shortening]] after fracture of the distal [[radius]] may be associated with tears of the [[triangular fibrocartilage]] complex (TFCC).
 
===Radial Inclination===
{| align="right"
|
[[File:Radial inclination of distal radius fracture.jpg|200px|thumb|none|Radial inclination of distal radius fracture [https://commons.wikimedia.org/wiki/File:Radial_inclination_of_distal_radius_fracture.jpg Source: Case courtesy of Mikael Häggström]]]
|}
*'''Method''':
**Radial inclination is the angle between a line perpendicular to the central axis of the [[radius]] and a line connecting the radial and ulnar limits of the articular surface of the distal [[radius]].
**The articular surface of the distal [[radius]] exhibits approximately 23° (range:13–30°) of normal radial inclination.
 
===Ulnar Variance===
*Ulnar variance, defined as neutral, positive, or negative, is evaluated on the frontal view.
*'''Method''':
**Ulnar variance, according to the method of perpendiculars, is the vertical distance between two tangential lines both  perpendicular to the long axis of the [[radius]].
**One line is drawn at the level of the radial sigmoid notch and the second at the level of the lateral cortical margin of the distal [[ulna]].
**With excessive radial [[shortening]], ulnar positive variance will be present.
 
===Radial translation ratio===
*'''Method''':
**The distal radioulnar joint gap is the distance between two longitudinal lines along the cortical rim of the sigmoid notch of the [[radius]] and the adjacent [[ulnar]] head.
**The fraction of the distal radioulnar joint gap relative to the radioulnar width of the proximal fracture fragment reflects the radial translation ratio.
**This ratio was is a significant  risk factor of distal radioulnar joint instability following unstable [[distal radius fracture]] and indicates tears of the [[triangular fibrocartilage]] complex (TFCC).
 
===Lateral View Inspection===
 
===Volar Tilt===
{| align="right"
|
[[File:Dorsal tilt of distal radius fracture.jpg|200px|thumb|none|Dorsal tilt of distal radius fracture. [https://upload.wikimedia.org/wikipedia/commons/e/ee/Dorsal_tilt_of_distal_radius_fracture.jpg Source: Case courtesy of Mikael Häggström]]]
|}
*The normal distal [[radius]] shows relative volar tilt.
*'''Method''':
**Volar tilt is the angle between a line perpendicular to the central axis of the [[radius]] and a line connecting the dorsal and volar margins of the articular surface of the distal [[radius]] on the lateral view.
**Loss of the normal volar tilt can accompany [[Bone fracture|fractures]] of the distal [[radius]].
**Extreme dorsal angulation may be associated with injury to the [[TFCC]].  


===Articular Surface===
===Teardrop angle===
Any articular joint surface must be smooth for it to function properly.
*The volar rim of the [[lunate]] facet of the distal radius forms a teardrop shape along the distal, volar surface of the radius on the lateral view.
The surface is not smooth if there is more than 1 [[millimeter|mm]] step deformity, and is associated with posttraumatic [[arthrosis]].
*'''Method''':
Irregularity may result in radiocarpal [[arthritis]], [[Pain and nociception|pain]], and stiffness.
**A teardrop angle can be acquired by drawing a line down the long axis of the radius that intersects a line drawn through the center of the lunate facet–teardrop.
If the surface is very irregular, the optimal treatment is fusion.
**A normal teardrop angle is approximately 70°.  
**This angle is used to determine whether there is persistent articular incongruity after reduction of a [[Fracture|fractured]] volar rim fragment.  


==References==
==References==
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[[Category:Orthopedic surgery]]
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[[Category:Fractures]]
[[Category:Bone fractures]]

Latest revision as of 21:25, 29 July 2020

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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

Radiographic imaging is important in diagnosis, classification, treatment and follow-up assessment of distal radius fractures. The routine minimal evaluation for distal radius fractures must include two views - a postero-anterior (PA) view and lateral view.

X Ray

Posteroanterior View Inspection

Radial Length

Radial Inclination

Radial inclination of distal radius fracture Source: Case courtesy of Mikael Häggström
  • Method:
    • Radial inclination is the angle between a line perpendicular to the central axis of the radius and a line connecting the radial and ulnar limits of the articular surface of the distal radius.
    • The articular surface of the distal radius exhibits approximately 23° (range:13–30°) of normal radial inclination.

Ulnar Variance

  • Ulnar variance, defined as neutral, positive, or negative, is evaluated on the frontal view.
  • Method:
    • Ulnar variance, according to the method of perpendiculars, is the vertical distance between two tangential lines both perpendicular to the long axis of the radius.
    • One line is drawn at the level of the radial sigmoid notch and the second at the level of the lateral cortical margin of the distal ulna.
    • With excessive radial shortening, ulnar positive variance will be present.

Radial translation ratio

  • Method:
    • The distal radioulnar joint gap is the distance between two longitudinal lines along the cortical rim of the sigmoid notch of the radius and the adjacent ulnar head.
    • The fraction of the distal radioulnar joint gap relative to the radioulnar width of the proximal fracture fragment reflects the radial translation ratio.
    • This ratio was is a significant risk factor of distal radioulnar joint instability following unstable distal radius fracture and indicates tears of the triangular fibrocartilage complex (TFCC).

Lateral View Inspection

Volar Tilt

Dorsal tilt of distal radius fracture. Source: Case courtesy of Mikael Häggström
  • The normal distal radius shows relative volar tilt.
  • Method:
    • Volar tilt is the angle between a line perpendicular to the central axis of the radius and a line connecting the dorsal and volar margins of the articular surface of the distal radius on the lateral view.
    • Loss of the normal volar tilt can accompany fractures of the distal radius.
    • Extreme dorsal angulation may be associated with injury to the TFCC.

Teardrop angle

  • The volar rim of the lunate facet of the distal radius forms a teardrop shape along the distal, volar surface of the radius on the lateral view.
  • Method:
    • A teardrop angle can be acquired by drawing a line down the long axis of the radius that intersects a line drawn through the center of the lunate facet–teardrop.
    • A normal teardrop angle is approximately 70°.
    • This angle is used to determine whether there is persistent articular incongruity after reduction of a fractured volar rim fragment.

References

  1. ↑ Metz VM, Gilula LA (1993). "Imaging techniques for distal radius fractures and related injuries". Orthop Clin North Am. 24 (2): 217–28. PMID 8479720.
  2. ↑ Henry MH (2008). "Distal radius fractures: current concepts". J Hand Surg Am. 33 (7): 1215–27. doi:10.1016/j.jhsa.2008.07.013. PMID 18762124.
  3. ↑ Medoff RJ (2005). "Essential radiographic evaluation for distal radius fractures". Hand Clin. 21 (3): 279–88. doi:10.1016/j.hcl.2005.02.008. PMID 16039439.
  4. ↑ Slutsky DJ (2005). "Predicting the outcome of distal radius fractures". Hand Clin. 21 (3): 289–94. doi:10.1016/j.hcl.2005.03.001. PMID 16039440.
  5. ↑ Lill CA, Goldhahn J, Albrecht A, Eckstein F, Gatzka C, Schneider E (2003). "Impact of bone density on distal radius fracture patterns and comparison between five different fracture classifications". J Orthop Trauma. 17 (4): 271–8. PMID 12679687.
  6. ↑ Nesbitt KS, Failla JM, Les C (2004). "Assessment of instability factors in adult distal radius fractures". J Hand Surg Am. 29 (6): 1128–38. doi:10.1016/j.jhsa.2004.06.008. PMID 15576227.
  7. ↑ Fujitani R, Omokawa S, Akahane M, Iida A, Ono H, Tanaka Y (2011). "Predictors of distal radioulnar joint instability in distal radius fractures". J Hand Surg Am. 36 (12): 1919–25. doi:10.1016/j.jhsa.2011.09.004. PMID 22036131.

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