Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Distal Radial Fracture Imaging

  • Author: Jack A Porrino, Jr, MD; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
 
Updated: Oct 20, 2015
 

Overview

The distal radial fracture is the most common fracture of the forearm and accounts for approximately 16% of all skeletal fractures. It is usually caused by a fall onto an outstretched hand (FOOSH). It can also result from direct impact or axial forces. The description of these fractures is based on distal radial angulation and displacement, intra-articular or extra-articular involvement, and associated anomalies of the ulnar or carpal bones.[1, 2, 3, 4, 5, 6, 7] See the images below.

Posteroanterior radiograph demonstrates a comminut Posteroanterior radiograph demonstrates a comminuted fracture of the distal radius. Note should be made of angulation and displacement, intra-articular or extra-articular involvement, and associated anomalies of the ulnar or carpal bones.
Lateral radiograph demonstrates a comminuted fract Lateral radiograph demonstrates a comminuted fracture of the distal radius. Note should be made of angulation and displacement, intra-articular or extra-articular involvement, and associated anomalies of the ulnar or carpal bones.

Most distal radial fractures are diagnosed by conventional radiography. Computed tomography (CT) and magnetic resonance imaging (MRI) are used in the evaluation of complex distal radial fractures, for the assessment of associated injuries, and for preoperative and postoperative management.[8, 9]

Wrist injuries that result in pain, edema, crepitus, deformity, or ecchymosis should be evaluated for distal radial fractures. Delayed diagnosis of a distal radial fracture can lead to significant morbidity.

There are numerous classification systems that describe fractures of the distal radius, traditionally chosen by the clinician based on preference.[5, 8] Classification systems should follow the following 2 principles:

  • The classification should dictate the treatment.
  • The classification should suggest the long-term, functional results of treatment or be correlated with these anticipated results. [2, 10, 11, 12, 13, 14]

As an example, the Universal Classification of Distal Radial Fractures (see Table 1 below) was proposed in 1990. This system differentiates between extra-articular and intra-articular fractures, as well as between stable and unstable fractures; it was created as a treatment-based algorithm.

Table 1. Universal Classification of Distal Radial Fractures (Open Table in a new window)

Classification Description
I Nonarticular, nondisplaced
II



A



B



C



Nonarticular, displaced



Reducible, stable



Reducible, unstable



Irreducible



III Articular, nondisplaced
IV



A



B



C



D



Articular, displaced



Reducible, stable



Reducible, unstable



Irreducible



Complex



 

Preferred examination

Posteroanterior (PA), lateral, and oblique radiographs of the injured wrist should be obtained.[15, 16, 17, 18] Oblique views may reveal intra-articular involvement that is not apparent on the other views. The semisupinated, oblique view demonstrates the dorsal facet of the lunate fossa, whereas the partially pronated, oblique PA view allows visualization of the radial styloid.[19]

Radial height is assessed on the PA view. It is a measurement between 2 parallel lines that are perpendicular to the long axis of the radius. One line is drawn on the articular surface of the radius, and the other is drawn at the tip of the radial styloid. The normal radial height is 9.9-17.3 mm.[20] Measurements of less than 9 mm in adults suggest the presence of comminuted or impacted fractures of the distal radius. Comparison with the contralateral normal wrist is recommended if the diagnosis is unclear (see images below).

Radial height (RH) is measured by drawing 2 parall Radial height (RH) is measured by drawing 2 parallel lines perpendicular to the long axis of the radius. Shortening of RH may indicate impaction of the distal radius when compared with a normal contralateral wrist. Ulnar variance (UV) is measured here by using the method of perpendiculars, in which 2 lines are drawn perpendicular to the long axis of the radius. One line is drawn on the ulnar-side articular surface of the radius, and the other is drawn on the ulnar carpal surface. This image demonstrates ulnar plus variance.
Posteroanterior view of an adult left wrist demons Posteroanterior view of an adult left wrist demonstrates an impacted distal radial fracture. Measurement of radial shortening and comparison with the contralateral normal wrist aids in the diagnosis.

Radial inclination is measured on the PA view; this is a measurement of the radial angle. A line is drawn along the articular surface of the radius perpendicular to the long axis of the radius, and a tangent is drawn from the radial styloid. The normal angle is 15-25º.[21, 22] Abnormal inclination of the distal radius may be a reflection of an impaction fracture of the distal radius (see image below).

The radial inclination is measured by drawing a li The radial inclination is measured by drawing a line perpendicular to the long axis of the radius and a tangential line from the radial styloid to the ulnar corner of the lunate fossa.

The volar tilt, or volar inclination, is measured on the lateral view. A line perpendicular to the long axis of the radius is drawn, and a tangent line is drawn along the slope of the dorsal-to-volar surface of the radius. The normal angle is 10-25º.[21, 22] A negative volar tilt indicates dorsal angulation of the distal, radial articular surface (see image below).[23]

The volar tilt, or palmar/volar inclination, is an The volar tilt, or palmar/volar inclination, is an angle between a line drawn perpendicular to the long axis of the radius and a tangential line drawn along the radial articular surface.

Ulnar variance is measured on PA radiographs. In adults, the following 3 methods are used[20] :

  • Project-a-line technique
  • Method of perpendiculars
  • Concentric-circle technique

Ulnar variance is described as being zero, minus, or plus. Positive (plus) or negative (minus) ulnar variance should be compared with the variance on the contralateral normal forearm.[21] Normal ulnar variance is 9-12 mm. Note that ulnar variance does not depend on the length of the ulnar styloid but on the positioning of the forearm, as well as on the radiographic technique.

Because fractures of the distal radius can be radiographically occult, an evaluation of the soft tissues of the distal forearm is important. For this assessment, 2 fat planes on the lateral view and 5 fat planes on the PA view are useful.

On the lateral view, the deep fat pad of the pronator quadratus and the dorsal skin subcutaneous fat line can be seen anterior to the distal radius. The deep fat pad of the pronator quadratus forms a slight, ventral concave line. This is convexly bowed in a ventral direction, disrupted, or completely obliterated in pathologic conditions.[24] The dorsal skin subcutaneous fat line is flat or is a dorsal concave line. It is abnormal when it is convex in the dorsal direction.

The PA view shows the thenar, hypothenar, pararadial, and paraulnar skin subcutaneous fat lines and the deep, navicular fat pad.

Swelling that is not associated with an observed fracture should initiate a search for an alternative abnormality or raise suspicion for a radiographically occult fracture.

Distal radial fractures that are not appropriately diagnosed with radiographic methods may result in increased morbidity when diagnosis is delayed. CT and MRI can be used to assess suspected occult fractures. Additionally, in instances of suspected clinically relevant soft-tissue injury, CT or MRI may be of benefit. Beware of the often-overlooked distal radioulnar subluxation/dislocation.[25, 26, 27, 28]

Goldwyn et al studied the use of traction radiography in the evaluation of distal radial fractures. They concluded that traction radiography may provide some of the same information as CT, but at a lower cost. They suggested further comparison between CT and traction radiography of the distal part of the radius as a result.[29]

Radiographic findings that are equivocal or potentially the result of normal anatomic variation require comparison with the contralateral wrist and/or additional imaging before intervention is recommended.[5]

Next

Radiography

Colles fracture

In 1814, Abraham Colles described the Colles fracture, which is reported to be the most common distal radial fracture. The injury is usually produced by a fall onto an outstretched hand (FOOSH). The impact produces a transverse fracture in the distal 2-3 cm of the radius. The fracture is dorsally displaced and may be comminuted. The fracture pattern is often described as a silver or dinner-fork deformity. The fracture fragments are usually impacted and comminuted along the dorsal aspect. The fracture can extend into the epiphysis to involve the distal radiocarpal joint or the distal radioulnar joint (see image below).[30, 19, 28]

Resnick noted that 50-60% of Colles fractures are associated with an ulnar styloid fracture.[31] An associated ulnar styloid fracture should prompt an investigation for tears of the triangular fibrocartilage (TFC). The TFC extends from the rim of the sigmoid notch of the distal radius to the ulnar styloid and assists with stabilizing the distal radioulnar joint.

Lateral view of the wrist demonstrates a Colles fr Lateral view of the wrist demonstrates a Colles fracture. There is dorsal displacement and angulation of the principal distal fracture fragment.

PA and lateral radiographs constitute the minimal examination. The examiner should note the direction and severity of displacement and angulation, extent of comminution, intra-articular involvement (radiocarpal and/or distal radioulnar joint), and radial length or variance in comparison with the normal side.

Two popular distal radial fracture classification systems are described below: the Association for Osteosynthesis (AO) system and the Frykman system (see Tables 2 and 3 below). Please see the Introduction section above for a description of the Universal Classification System.

Table 2. AO Classification of Distal Radius Fractures (Open Table in a new window)

Type Description
A Extra-articular
B Partial articular
 



C



1



2



3



Complete articular



Simple articular and metaphyseal fracture



Simple articular with complex metaphyseal fracture



Complex articular and metaphyseal fracture



Table 3. Frykman Classification of Distal Radius Fractures (Open Table in a new window)

Type Radius Ulna Radiocarpal Radioulnar
I Extra-articular Absent Absent Absent
II Extra-articular Present Absent Absent
III Intra-articular Absent Present Absent
IV Intra-articular Present Present Absent
V Intra-articular Absent Absent Present
VI Intra-articular Present Absent Present
VII Intra-articular Absent Present Present
VIII Intra-articular Present Present Present

The AO and Frykman classifications are useful in discussing prognosis.

Complications of the Colles fracture include compressive neuropathy, posttraumatic arthrosis, Volkmann ischemic contracture, acute carpal tunnel syndrome, and shoulder-hand syndrome.[22]

Colles fractures occur more frequently in elderly persons, as a result of osteoporosis.[23, 32]

Smith fracture

Robert Smith described the Smith fracture in 1847. An impact to the dorsum of the hand or a hyperflexion or hypersupination injury is thought to be the cause. A Smith fracture is usually called a reverse Colles fracture because the distal fragment is displaced volarly. It is often described as a garden-spade deformity. The ulnar head can be displaced dorsally (see images below).

Posteroanterior radiograph exhibiting a fracture o Posteroanterior radiograph exhibiting a fracture of the distal radius.
Lateral radiograph demonstrates volar displacement Lateral radiograph demonstrates volar displacement of the principal distal fracture fragment, described by Smith.

The criteria used to evaluate and describe Colles fractures also apply to Smith fractures. In 1957, F. Brian Thomas created the Thomas Classification of Smith fractures (see Table 4 and image below).[33]

Table 4. Thomas Classification of Smith Fractures (Open Table in a new window)

Type Description
I Most stable, extra-articular, transverse distal radial fracture with volar and proximal displacement
II Barton type, volar-lip fracture of the distal radius with volar and proximal dislocation of the carpus
III Unstable, oblique, juxta-articular fracture of the distal radius with volar displacement and volar tilt of the distal radius

 

Illustration of the Thomas classification of Smith Illustration of the Thomas classification of Smith fractures.

The complications of Smith fractures are similar to those of Colles fractures.

Barton fracture

John Rhea Barton characterized the Barton fracture in 1838.[22] This fracture involves a dorsal rim injury of the distal portion of the radius. The volar Barton fracture is thought to occur with the same mechanism as the Smith fracture, with more force and loading on the wrist. The dorsal Barton fracture is caused by a fall onto an extended and pronated wrist, increasing carpal compression force on the dorsal rim. The salient feature is a subluxation of the wrist in this die-punch injury.

The Barton fracture involves either the volar or dorsal radial rim, and the mechanism is intra-articular. By definition, this fracture has some degree of carpal displacement. The volar variety is more common than the dorsal type.[22]

PA and lateral views of the wrist constitute the minimal examination. A true lateral projection is needed to evaluate the degree of carpal subluxation.

In 1992, Wood and Berquist suggested that trispiral tomograms or coronal and/or sagittal CT could be used to evaluate articular congruity of the distal radius.[22]

Barton fractures are classified as dorsal or volar (always intra-articular), and they always involve carpal subluxation.

Complications of Barton fractures are similar to those of Colles fractures.

Hutchinson, chauffeur's, or radial styloid fracture

The chauffeur's fracture derives its name from injuries that were acquired in the days when motor vehicles were cranked, when a vehicle backfired. The force is described as a direct axial compression of the scaphoid into the radial facet. The radial styloid is fractured, with associated avulsion of the radial collateral ligament (see image below).[22, 31] A chauffeur's fracture represents an avulsion related to the attachment sites of the radiocarpal ligaments or of the radial collateral ligament. Scapholunate dissociation and lesser arc injuries of the wrist may be indicated by a fracture line on the radial articular surface between the scaphoid and lunate fossae.

Oblique radiograph of a chauffeaur fracture. Note Oblique radiograph of a chauffeaur fracture. Note the fracture extending through the radial styloid.

The PA view usually demonstrates the lesion. Wood and Berquist report that little or no abnormality is seen on lateral views.[22]

Chauffeur's fractures are classified as simple or comminuted radial styloid fractures and as displaced or nondisplaced fractures. These injuries show no evidence of carpal subluxation.

Complications include scapholunate dislocation, osteoarthritis, and ligamentous damage.

Galeazzi, or Piedmont, fracture

A Galeazzi fracture results from a FOOSH mechanism with the forearm hyperpronated, or from a direct impact to the dorsal radial wrist. The radial diaphysis at the distal and middle third junction is fractured, with associated subluxation/dislocation of the distal radioulnar joint. There may be resultant shortening of the radius.

PA views demonstrate the radial fracture, and potentially subluxation/dislocation of the distal radioulnar joint. Distal radioulnar distances greater than 2 mm are suggestive of a ligamentous injury and/or a tear of the TFC.

The lateral view may be necessary to identify the distal radioulnar subluxation/dislocation. On the lateral view, the distal radius may be angulated volarly as a result of the pull of the brachioradialis muscle.[22, 34]

An associated ulnar styloid fracture may be present.

Classification is based on the direction of displacement of the distal fracture fragment.

Complications include radial malunion, nonunion, and persistent subluxation of the radioulnar joint.[22]

Pediatric distal radial fracture

The distal one third of the forearm is the most common fracture site in children. Dicke notes that these represent 35.8-45% of all pediatric fractures. The primary mechanism of injury is a FOOSH. Unlike such falls in adults, these falls rarely lead to intra-articular fractures in children, but fractures can occur at the diaphyseal-metaphyseal junction or at the physis. Boys have a higher frequency of distal radial fractures than do girls.

Five classifications of pediatric fractures are used, as follows[35] :

  • Plastic deformation - This occurs most commonly in the ulna and fibula.
  • Buckle (torus) fracture - The diaphysis (cortical bone) causes the metaphysis to buckle under compressive forces.
  • Greenstick fracture - This fracture occurs when the tension side of the bone fails as it is bent.
  • Complete fracture - A complete fracture propagates through the entire bone and can occur as a spiral fracture, an oblique fracture, or a transverse fracture.
  • Physeal fracture - This fracture involves the growth plate. The distal radial physis is the most frequently injured physis.

Fractures involving the physis are categorized as follows, using the Salter-Harris (SH) classification:

  • Type I - A fracture through the physis.
  • Type II - A fracture through the physis and obliquely through the metaphysis.
  • Type III - A fracture through a portion of the physis and longitudinally through the epiphysis.
  • Type IV - An oblique fracture extending through the metaphysis, physis, and epiphysis.

A displaced pronator fat sign may be the only indication of a nondisplaced Salter-Harris type I fracture. Salter-Harris type II fractures are the most common, according to Waters,[36] reflecting 58% of the fractures considered in a 1993 study by Dicke.

Complications of pediatric distal radius fractures include nonunion or malunion, growth-plate arrest that leads to deformity, nerve and vessel damage, sympathetic dystrophy, overgrowth of the healing bone, and compartment syndrome.

Previous
Next

Computed Tomography

Computed tomography (CT) is used to plan operative repair, providing improved accuracy for evaluation of fracture alignment and articular involvement.[19, 28]

CT is also a useful modality for resolving uncertain findings on conventional radiographs, such as the presence of a potential radiographically occult fracture.

In the postoperative setting, fracture healing can be assessed.

Optimal results are obtained when sagittal and coronal reformatted images are used in conjunction with imaging in the axial plane (see images below).

Axial computed tomography (CT) scan demonstrates a Axial computed tomography (CT) scan demonstrates a comminuted distal radial fracture.
Coronal computed tomography (CT) scan demonstrates Coronal computed tomography (CT) scan demonstrates intra-articular radiocarpal joint involvement in a distal radial fracture.
Sagittal computed tomography (CT) scan demonstrate Sagittal computed tomography (CT) scan demonstrates a comminuted distal radial fracture with intra-articular radiocarpal joint involvement.
Previous
Next

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is not routinely used in the initial evaluation of acute distal radial fractures. However, the modality is useful in the assessment of additional bony, ligamentous, and soft-tissue abnormalities associated with distal radial fractures and may be helpful in detecting the radiographically occult distal radius fracture (see images below).[27]

Posteroanterior radiograph of the wrist demonstrat Posteroanterior radiograph of the wrist demonstrates a barely perceptible sclerotic fracture of the distal radial metaphysis.
T1-weighted MRI in the same patient exhibits the h T1-weighted MRI in the same patient exhibits the hypointense, nondisplaced fracture of the distal radial metaphysis.
T2-weighted MRI of the wrist in the same patient e T2-weighted MRI of the wrist in the same patient exhibits linear bone marrow edema within the distal radial metaphysis corresponding to a sublte, and near radiographically occult, fracture.

MRI is routinely used to evaluate the integrity of the intercarpal ligaments, the TFC, and the median nerve within the carpal tunnel when injury to these structures is suspected in conjunction with fracture of the distal radius.

Compared with radiographs and scintigrams, MRI may be more sensitive in detecting early posttraumatic osteonecrosis of the carpus that may occur with distal radius fractures.

Degree of confidence

The improved contrast resolution afforded by MRI improves the detection of marrow edema at the site of fracture, which is not detectable on CT scans.

Wood and Berquist quote a sensitivity of 100% and a specificity of 92% for MRI in the detection of TFC tears, compared with a sensitivity and specificity of 89% and 90%, respectively, for arthrography.[22]

Previous
Next

Ultrasonography

Ultrasonography may be used in pediatric patients to visualize the physes of children in whom mineralization of secondary growth plates has yet to occur. Ultrasonography may also be used in patients who lack bony landmarks. On ultrasonograms, cortical surfaces are echogenic or echoreflective, whereas cartilage or unossified physes are sonolucent or hypoechoic.[37]

Bianchi et al found that ultrasonography is an effective, dynamic, and noninvasive technique with which to diagnose and evaluate damage to the extensor tendons and their synovial sheaths. The authors analyzed ultrasound examinations of 9 consecutive patients with a history of distal radial fractures treated by open reduction and internal fixation of the volar plate.[38]

Previous
Next

Nuclear Imaging

Nuclear scintigraphy can be used to detect fractures because the early osteoblastic reaction at fracture margins results in a focal linear accumulation of technetium-99m (99m Tc) methylene diphosphonate (MDP) at the site. However, reports describe poor accumulation of the radiotracer in patients with congestive heart failure or chronic renal failure and in the elderly.[37]

If bony, cartilaginous, or ligamentous abnormalities are suspected despite normal radiographs, radionuclide bone imaging may be helpful. An occult fracture or other osteochondral pathology must be excluded when an area of intense focal tracer accumulation is noted. Mildly increased focal tracer uptake suggests ligamentous or cartilaginous pathology. Lack of focal tracer accumulation on delayed images excludes osteochondral involvement.

Radionuclide bone imaging may be helpful in determining the age of a fracture and for documenting fracture healing when radiographic results are inconclusive. It is also important in the diagnosis of reflex sympathetic dystrophy (RSD).

Degree of confidence

Bone scintiscan findings may remain positive for as long as 2 years as a result of vascular recruitment from trauma.[37]

Metz and Gilula quote a sensitivity and specificity of 96% and 97%, respectively, in the diagnosis of RSD by using radionuclide bone imaging.[39]

Previous
Next

Angiography

Angiography is indicated in cases involving a compromise of vascular structures, as reflected in the clinical presentation.

Previous
 
Contributor Information and Disclosures
Author

Jack A Porrino, Jr, MD Assistant Professor of Diagnostic Radiology, Department of Radiology, University of Washington School of Medicine

Jack A Porrino, Jr, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Radiological Society of North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand

Disclosure: Nothing to disclose.

Theodore E Keats, MD Professor, Departments of Radiology and Orthopedics, University of Virginia School of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, MEd Professor, Department of Radiology, Vice Chairman for Academic Innovation, Section Head of Musculoskeletal Radiology, University of Washington School of Medicine

Felix S Chew, MD, MBA, MEd is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America

Disclosure: Nothing to disclose.

Additional Contributors

Leon Lenchik, MD Program Director and Associate Professor of Radiologic Sciences-Radiology, Wake Forest University Baptist Medical Center

Leon Lenchik, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Radiological Society of North America

Disclosure: Nothing to disclose.

Acknowledgements

William D Craig, MD, MBA Radiologist, GCM Radiology

William D Craig, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American College of Radiology, American Roentgen Ray Society, Radiological Society of North America, and Society of Uroradiology

Disclosure: Nothing to disclose.

Browyn Richards, MD Staff Physician, Department of Family Practice, Boone Branch Medical Clinic, Portsmouth Naval Hospital

Disclosure: Nothing to disclose.

Ricardo Riego de Dios, MD Staff Physician, Department of Diagnostic Radiology, Naval Hospital Jacksonville, Naval Air Station

Ricardo Riego de Dios, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Phi Beta Kappa, and Radiological Society of North America

Disclosure: Nothing to disclose.

References
  1. Souer JS, Lozano-Calderon SA, Ring D. Predictors of wrist function and health status after operative treatment of fractures of the distal radius. J Hand Surg Am. 2008 Feb. 33(2):157-163. [Medline].

  2. Cooney WP. Fractures of the distal radius. A modern treatment-based classification. Orthop Clin North Am. 1993 Apr. 24(2):211-6. [Medline].

  3. Burton EM, Brody AS. Musculoskeletal system. Essentials of Pediatric Radiology. New York, NY: Thieme Medical Pubs; 1999. 221-8.

  4. Maschke SD, Evans PJ, Schub D, Drake R, Lawton JN. Radiographic evaluation of dorsal screw penetration after volar fixed-angle plating of the distal radius: a cadaveric study. Hand (N Y). 2007 Sep. 2(3):144-50. [Medline]. [Full Text].

  5. Lill CA, Goldhahn J, Albrecht A, Eckstein F, Gatzka C, Schneider E. Impact of bone density on distal radius fracture patterns and comparison between five different fracture classifications. J Orthop Trauma. 2003 Apr. 17(4):271-8. [Medline].

  6. Belloti JC, Tamaoki MJ, Franciozi CE, Santos JB, Balbachevsky D, Chap Chap E. Are distal radius fracture classifications reproducible? Intra and interobserver agreement. Sao Paulo Med J. 2008 May 1. 126(3):180-5. [Medline].

  7. Nesbitt KS, Failla JM, Les C. Assessment of instability factors in adult distal radius fractures. J Hand Surg Am. 2004 Nov. 29(6):1128-38. [Medline].

  8. Henry MH. Distal radius fractures: current concepts. J Hand Surg Am. 2008 Sep. 33(7):1215-27. [Medline].

  9. Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005 Aug. 21(3):279-88. [Medline].

  10. Batra S, Debnath U, Kanvinde R. Can carpal malalignment predict early and late instability in nonoperatively managed distal radius fractures?. Int Orthop. 2007 Jun 19. [Medline].

  11. Chang HC, Poh SY, Seah SC, et al. Fragment-specific fracture fixation and double-column plating of unstable distal radial fractures using AO mini-fragment implants and Kirschner wires. Injury. 2007 Nov. 38(11):1259-67. [Medline].

  12. Chung KC, Petruska EA. Treatment of unstable distal radial fractures with the volar locking plating system. Surgical technique. J Bone Joint Surg Am. 2007 Sep. 89 Suppl 2 Pt.2:256-66. [Medline].

  13. Földhazy Z, Törnkvist H, Elmstedt E, et al. Long-term outcome of nonsurgically treated distal radius fractures. J Hand Surg [Am]. 2007 Nov. 32(9):1374-84. [Medline].

  14. Rein S, Schikore H, Schneiders W, et al. Results of dorsal or volar plate fixation of AO type C3 distal radius fractures: a retrospective study. J Hand Surg [Am]. 2007 Sep. 32(7):954-61. [Medline].

  15. Bozentka DJ, Beredjiklian PK, Westawski D, et al. Digital radiographs in the assessment of distal radius fracture parameters. Clin Orthop Relat Res. 2002 Apr. (397):409-13. [Medline].

  16. Johnston GH, Friedman L, Kriegler JC. Computerized tomographic evaluation of acute distal radial fractures. J Hand Surg [Am]. 1992 Jul. 17(4):738-44. [Medline].

  17. Rogers LF. Traumatic Lesions of Bones and Joints. Juhl JH, Crummy AB, eds. Paul and Juhls' Essentials of Radiologic Imaging. 6th ed. Philadelphia, Pa: JB Lippincott; 1993. 33-64.

  18. Spence LD, Savenor A, Nwachuku I. MRI of fractures of the distal radius: comparison with conventional radiographs. Skeletal Radiol. 1998 May. 27(5):244-9. [Medline].

  19. Suojärvi N, Sillat T, Lindfors N, Koskinen SK. Radiographical measurements for distal intra-articular fractures of the radius using plain radiographs and cone beam computed tomography images. Skeletal Radiol. 2015 Dec. 44 (12):1769-75. [Medline].

  20. Keats TE, Sistrom C. Atlas of Radiologic Measurement. 7th ed. Philadelphia, Pa: Harcourt Health Sciences; 2001. 186-99.

  21. Greenspan A. Orthopedic Radiology: A Practical Approach. Philadelphia, Pa: JB Lippincott; 1988. 4.3-4.12.

  22. Wood MB, Berquist TH. The hand and wrist. Berquist TH. Imaging of Orthopedic Trauma. New York, NY: Raven Press; 1992. 749-870.

  23. Hanel DP, Jones MD, Trumble TE. Wrist fractures. Orthop Clin North Am. 2002 Jan. 33(1):35-57, vii. [Medline].

  24. Fallahi F, Jafari H, Jefferson G, Jennings P, Read R. Explorative study of the sensitivity and specificity of the pronator quadratus fat pad sign as a predictor of subtle wrist fractures. Skeletal Radiol. 2013 Feb. 42(2):249-53. [Medline]. [Full Text].

  25. Miyake J, Murase T, Yamanaka Y, Moritomo H, Sugamoto K, Yoshikawa H. Three-dimensional deformity analysis of malunited distal radius fractures and their influence on wrist and forearm motion. J Hand Surg Eur Vol. 2012 Jul. 37(6):506-12. [Medline].

  26. Jørgsholm P, Thomsen NO, Besjakov J, Abrahamsson SO, Björkman A. The benefit of magnetic resonance imaging for patients with posttraumatic radial wrist tenderness. J Hand Surg Am. 2013 Jan. 38(1):29-33. [Medline].

  27. Lewis M, Ebreo D, Malcolm PN, Greenwood R, Patel AD, Kasmai B, et al. Pharmacokinetic modeling of multislice dynamic contrast-enhanced MRI in normal-healing radial fractures: A pilot study. J Magn Reson Imaging. 2015 Sep 2. [Medline].

  28. Avery DM 3rd, Matullo KS. Distal radial traction radiographs: interobserver and intraobserver reliability compared with computed tomography. J Bone Joint Surg Am. 2014 Apr 2. 96 (7):582-8. [Medline].

  29. Goldwyn E, Pensy R, O'Toole RV, Nascone JW, Sciadini MF, LeBrun C, et al. Do traction radiographs of distal radial fractures influence fracture characterization and treatment?. J Bone Joint Surg Am. 2012 Nov 21. 94(22):2055-62. [Medline].

  30. Warwick D, Prothero D, Field J, et al. Radiological measurement of radial shortening in Colles' fracture. J Hand Surg [Br]. 1993 Feb. 18(1):50-2. [Medline].

  31. Resnick D. Physical injury: extraspinal sites. Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia, Pa: WB Saunders; 2002. 2783-933.

  32. Muller M, Mitton D, Moilanen P, et al. Prediction of bone mechanical properties using QUS and pQCT: Study of the human distal radius. Med Eng Phys. 2007 Nov 5. [Medline].

  33. Thomas FB. Reduction of Smith's fracture. J Bone Joint Surg Br. 1957 Aug. 39-B(3):463-70. [Medline].

  34. Meschan I. Fractures and dislocations of the extremities. Roentgen Signs in Diagnostic Imaging. 2nd ed. Philadelphia, Pa: WB Saunders; 1985. vol 2, Appendicular Skeleton: 55-81.

  35. Armstrong PF, Joughlin VE, Clarke HM. Pediatric fractures of the forearm, wrist, and hand. Green NE, Swiontkowski MF. Skeletal Trauma in Children. 2nd ed. Philadelphia, Pa: WB Saunders; 1998. 161-96.

  36. Waters PM. Distal radius and ulna fractures. Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children. 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001.

  37. Eustace S, Adams J, Assaf A. Emergency MR imaging of orthopedic trauma. Current and future directions. Radiol Clin North Am. 1999 Sep. 37(5):975-94, vi. [Medline].

  38. Bianchi S, van Aaken J, Glauser T, Martinoli C, Beaulieu JY, Della Santa D. Screw impingement on the extensor tendons in distal radius fractures treated by volar plating: sonographic appearance. AJR Am J Roentgenol. 2008 Nov. 191(5):W199-203. [Medline].

  39. Metz VM, Gilula LA. Imaging techniques for distal radius fractures and related injuries. Orthop Clin North Am. 1993 Apr. 24(2):217-28. [Medline].

 
Previous
Next
 
Radial height (RH) is measured by drawing 2 parallel lines perpendicular to the long axis of the radius. Shortening of RH may indicate impaction of the distal radius when compared with a normal contralateral wrist. Ulnar variance (UV) is measured here by using the method of perpendiculars, in which 2 lines are drawn perpendicular to the long axis of the radius. One line is drawn on the ulnar-side articular surface of the radius, and the other is drawn on the ulnar carpal surface. This image demonstrates ulnar plus variance.
Posteroanterior view of an adult left wrist demonstrates an impacted distal radial fracture. Measurement of radial shortening and comparison with the contralateral normal wrist aids in the diagnosis.
The radial inclination is measured by drawing a line perpendicular to the long axis of the radius and a tangential line from the radial styloid to the ulnar corner of the lunate fossa.
The volar tilt, or palmar/volar inclination, is an angle between a line drawn perpendicular to the long axis of the radius and a tangential line drawn along the radial articular surface.
Lateral view of the wrist demonstrates a Colles fracture. There is dorsal displacement and angulation of the principal distal fracture fragment.
Illustration of the Thomas classification of Smith fractures.
Oblique radiograph of a chauffeaur fracture. Note the fracture extending through the radial styloid.
Posteroanterior view of the left wrist demonstrates buckle fractures of the distal radius and ulna.
Axial computed tomography (CT) scan demonstrates a comminuted distal radial fracture.
Coronal computed tomography (CT) scan demonstrates intra-articular radiocarpal joint involvement in a distal radial fracture.
Sagittal computed tomography (CT) scan demonstrates a comminuted distal radial fracture with intra-articular radiocarpal joint involvement.
Posteroanterior radiograph of the wrist demonstrates a barely perceptible sclerotic fracture of the distal radial metaphysis.
T1-weighted MRI in the same patient exhibits the hypointense, nondisplaced fracture of the distal radial metaphysis.
T2-weighted MRI of the wrist in the same patient exhibits linear bone marrow edema within the distal radial metaphysis corresponding to a sublte, and near radiographically occult, fracture.
Posteroanterior radiograph exhibiting a fracture of the distal radius.
Lateral radiograph demonstrates volar displacement of the principal distal fracture fragment, described by Smith.
Posteroanterior radiograph demonstrates a comminuted fracture of the distal radius. Note should be made of angulation and displacement, intra-articular or extra-articular involvement, and associated anomalies of the ulnar or carpal bones.
Lateral radiograph demonstrates a comminuted fracture of the distal radius. Note should be made of angulation and displacement, intra-articular or extra-articular involvement, and associated anomalies of the ulnar or carpal bones.
Table 1. Universal Classification of Distal Radial Fractures
Classification Description
I Nonarticular, nondisplaced
II



A



B



C



Nonarticular, displaced



Reducible, stable



Reducible, unstable



Irreducible



III Articular, nondisplaced
IV



A



B



C



D



Articular, displaced



Reducible, stable



Reducible, unstable



Irreducible



Complex



Table 2. AO Classification of Distal Radius Fractures
Type Description
A Extra-articular
B Partial articular
 



C



1



2



3



Complete articular



Simple articular and metaphyseal fracture



Simple articular with complex metaphyseal fracture



Complex articular and metaphyseal fracture



Table 3. Frykman Classification of Distal Radius Fractures
Type Radius Ulna Radiocarpal Radioulnar
I Extra-articular Absent Absent Absent
II Extra-articular Present Absent Absent
III Intra-articular Absent Present Absent
IV Intra-articular Present Present Absent
V Intra-articular Absent Absent Present
VI Intra-articular Present Absent Present
VII Intra-articular Absent Present Present
VIII Intra-articular Present Present Present
Table 4. Thomas Classification of Smith Fractures
Type Description
I Most stable, extra-articular, transverse distal radial fracture with volar and proximal displacement
II Barton type, volar-lip fracture of the distal radius with volar and proximal dislocation of the carpus
III Unstable, oblique, juxta-articular fracture of the distal radius with volar displacement and volar tilt of the distal radius
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.