Distal radius fracture differential diagnosis

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Differentiating Distal radius fracture from other Diseases

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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

Distal radius fracture must be differentiated from wrist strain, ligamentous carpal injury such as scapholunate ligament and triangular fibrocartilage complex (TFCC) tear.

Differentiating Distal Radius Fracture from other Diseases

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Imaging
Pain Restriction of Movements Deformity Tenderness Decreased Grip Strength Decreased sensation in course of Median nerve X-ray CT scan MRI
Distal radius fracture + + + + + +/-
  • Distal fragment displacement
  • Distal fragment angulation
  • Radial shortening
  • Useful for preoperative surgical planning for patients with complex, multifragmentary fractures.
X-ray
Wrist strain + + - + - - MRI
Ligamentous carpal injury + + +/- + - -
  • Swelling and tear of the ligament may be seen
MRI
  • Most common injury is scapholunate ligament tear with widening of the scapholunate interval.
  • Positive Watson shift test.
Triangular fibrocartilage complex (TFCC) tear + +/- - + - -
  • Swelling and tear of the ligament may be seen
MRI

References

  1. Trumble TE, Benirschke SK, Vedder NB (1993). "Ipsilateral fractures of the scaphoid and radius". J Hand Surg Am. 18 (1): 8–14. doi:10.1016/0363-5023(93)90237-W. PMID 8423324.
  2. Stoffelen D, De Mulder K, Broos P (1998). "The clinical importance of carpal instabilities following distal radial fractures". J Hand Surg Br. 23 (4): 512–6. PMID 9726557.
  3. May MM, Lawton JN, Blazar PE (2002). "Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability". J Hand Surg Am. 27 (6): 965–71. doi:10.1053/jhsu.2002.36525. PMID 12457345.
  4. Lindau T (2005). "Treatment of injuries to the ulnar side of the wrist occurring with distal radial fractures". Hand Clin. 21 (3): 417–25. doi:10.1016/j.hcl.2005.04.002. PMID 16039453.

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