Distal radius fracture differential diagnosis: Difference between revisions

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{{Distal radius fracture}}
{{Distal radius fracture}}
{{CMG}}; {{AE}} {{Rohan}}
{{CMG}}; {{AE}} {{Rohan}}


==Overview==
==Overview==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
[[Distal radius fracture]] must be differentiated from [[wrist strain]], [[Ligamentous laxity|ligamentous]] carpal injury such as [[scapholunate]] ligament and [[triangular fibrocartilage]] complex (TFCC) tear.


OR
==Differentiating Distal Radius Fracture from other Diseases==
* [[Distal radius fracture]] must be differentiated from other diseases that [[wrist pain]], [[restriction of movements]], and [[deformity]], such as [[wrist strain]], [[Ligamentous laxity|ligamentous]] carpal injury such as [[scapholunate ligament]] and [[triangular fibrocartilage]] complex (TFCC) tear.<ref name="pmid8423324">{{cite journal| author=Trumble TE, Benirschke SK, Vedder NB| title=Ipsilateral fractures of the scaphoid and radius. | journal=J Hand Surg Am | year= 1993 | volume= 18 | issue= 1 | pages= 8-14 | pmid=8423324 | doi=10.1016/0363-5023(93)90237-W | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8423324  }} </ref><ref name="pmid9726557">{{cite journal| author=Stoffelen D, De Mulder K, Broos P| title=The clinical importance of carpal instabilities following distal radial fractures. | journal=J Hand Surg Br | year= 1998 | volume= 23 | issue= 4 | pages= 512-6 | pmid=9726557 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9726557  }} </ref><ref name="pmid12457345">{{cite journal| author=May MM, Lawton JN, Blazar PE| title=Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. | journal=J Hand Surg Am | year= 2002 | volume= 27 | issue= 6 | pages= 965-71 | pmid=12457345 | doi=10.1053/jhsu.2002.36525 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12457345  }} </ref><ref name="pmid16039453">{{cite journal| author=Lindau T| title=Treatment of injuries to the ulnar side of the wrist occurring with distal radial fractures. | journal=Hand Clin | year= 2005 | volume= 21 | issue= 3 | pages= 417-25 | pmid=16039453 | doi=10.1016/j.hcl.2005.04.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16039453  }} </ref>


[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
==Differentiating [Disease name] from other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].
OR
As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
===Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]===
On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Para-clinical findings
! colspan="3" rowspan="2" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Histopathology
|-  
|-  
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 2
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Restriction of Movements
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Deformity
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 2
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Decreased Grip Strength
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Decreased sensation in course of Median nerve
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 3
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
| style="background: #F5F5F5; padding: 5px;" |
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|-
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Distal radius fracture]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
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* Distal fragment displacement
* Distal fragment angulation
* Radial shortening
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Useful for preoperative surgical planning for patients with complex, multifragmentary fractures.
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Useful in diagnosing occult [[Bone fracture|fractures]], [[Ligamentous laxity|ligamentous]] and [[soft tissue]] injuries
| style="background: #F5F5F5; padding: 5px;" |X-ray
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diseases
!Symptom 1
! colspan="1" rowspan="1" |Symptom 2
!Symptom 3
!Physical exam 1
! colspan="1" rowspan="1" |Physical exam 2
!Physical exam 3
!Lab 1
!Lab 2
!Lab 3
!Imaging 1
!Imaging 2
!Imaging 3
!Histopathology
|'''Gold standard'''
!Additional findings
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Wrist strain
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
| style="background: #F5F5F5; padding: 5px;" |
* No evidence of [[Bone fracture|fracture]] on radiographs
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* No evidence of [[Bone fracture|fracture]] on CT
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Soft tissue]] swelling and tear may be seen
| style="background: #F5F5F5; padding: 5px;" |MRI
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ligamentous carpal injury
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
| style="background: #F5F5F5; padding: 5px;" |
* No evidence of [[Bone fracture|fracture]] on radiographs
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* No evidence of [[Bone fracture|fracture]] on CT
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Swelling and tear of the [[ligament]] may be seen
| style="background: #F5F5F5; padding: 5px;" |MRI
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Most common injury is [[scapholunate]] ligament tear with widening of the scapholunate interval.
* Positive Watson shift test.
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 6
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Triangular fibrocartilage]] complex (TFCC) tear
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
| style="background: #F5F5F5; padding: 5px;" |
* No evidence of [[Bone fracture|fracture]] on radiographs
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* No evidence of [[Bone fracture|fracture]] on CT
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Swelling and tear of the [[ligament]] may be seen
| style="background: #F5F5F5; padding: 5px;" |MRI
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Wrist [[arthroscopy]] can be useful in visualizing and repairing [[TFCC tear]]
|}
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[[Category:Needs content]]
[[Category:Needs content]]
[[Category:Orthopedics]]
[[Category:Orthopedics]]
[[Category:Orthopedic surgery]]
[[Category:Orthopedic surgery]]
[[Category:Primary care]]
[[Category:Fractures]]
[[Category:Fractures]]
[[Category:Bone fractures]]
[[Category:Bone fractures]]

Latest revision as of 21:25, 29 July 2020

Distal radius fracture Microchapters

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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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