Anatomy Msk · Year 1 · from Anatomy Msk
Case 1: Distal Radius Fracture with Appropriate Imaging Selection
Clinical Image
Source: Wikimedia Commons - Colles Fracture - CC BY-SA 3.0
Case Presentation
A 68-year-old woman presents to the emergency department after slipping on ice and landing on her outstretched right hand. She reports immediate pain and visible deformity of her right wrist. Physical examination reveals a "dinner fork" deformity with dorsal angulation at the distal wrist. There is significant swelling, tenderness, and limited range of motion. Neurovascular examination reveals intact sensation in the median, ulnar, and radial nerve distributions with palpable radial pulse. Standard PA and lateral radiographs of the wrist are obtained, which demonstrate a distal radius fracture with dorsal angulation (Colles fracture), dorsal comminution, and shortening of 5 mm. The fracture extends into the radiocarpal joint (intra-articular). Given the intra-articular nature and comminution, CT scan is obtained to better characterize the articular surface and surgical planning. CT confirms a two-part intra-articular fracture with 2 mm step-off at the articular surface. She undergoes open reduction and internal fixation with a volar locking plate. Post-operative radiographs confirm anatomic restoration of radial length, inclination, and volar tilt.
Key Learning Points
- Radiographs (X-rays) are the first-line imaging modality for suspected fractures - fast, inexpensive, low radiation
- Standard orthogonal views (two views 90 degrees apart) are essential; special views may be needed for specific injuries
- CT provides superior bony detail and is indicated for complex fractures, articular involvement, and preoperative planning
- Key parameters for distal radius: radial inclination (22 degrees), radial length (11 mm), volar tilt (11 degrees)
- Intra-articular step-off >2 mm and radial shortening >5 mm are indications for operative fixation