Standardized Imaging Evaluation of Distal Radius Fractures

Objectives: To analyze the imaging signs in distal radius fractures systematically, determine injury extent by using standardized radiography and computed tomography (CT), as well as ultimately to recommend measurement parameters and a useful diagnostic algorithm.

Methods: A total of 150 patients with distal radius fractures underwent radiographic examination. Additionally, 98 of them received CT imaging and 39, CT arthrography (CTA). A total of 11 measurement parameters were applied for standardized evaluation including teardrop angle, coronal and sagittal tilts, and articular step-off, among others. In CTA, associated injuries of the scapholunate interosseus ligament (SLIL) and the triangular fibrocartilage complex (TFCC) were evaluated.

Results: In radiography, teardrop angle, sagittal diameter of the radius, projection of the dorsal radial rim, radial tilt, radial inclination, and ulnar variance were sufficient to quantify displaced fragments in extra-articular fractures. However, CT imaging was superior in measuring the number of fragments, quantifying articular fracture widths and step-offs, as well as detecting occult fractures. CTA revealed treatment-requiring SLIL injuries in 12 (31%) and TFCC lesions in 22 patients (54%) with intra-articular fractures of the distal radius.

Conclusion: A proven algorithm (checklist) in radiographic and CT imaging is helpful to detect and stage distal radius fractures. Precise measurement parameters applied in the AO or Fernandez classification of fractures provide the surgeon with relevant therapeutic information. CT imaging is essential in intra-articular radius fractures; CTA is recommended when additional SLIL or TFCC lesions are suspected.