Orthopedic Care and Consultation
It is also called radial height.
Radial length is measured on the postreoanterior radiograph.
It is measured as the distance between following two lines.
First line is drawn perpendicular to the long axis of the radius passing through the distal tip of the radial styloid.
Second line is along the articular surface of radius.
The average value of this measurement averages 10-13 mm.
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Radial inclination is also termed as radial angle.
This measurement is taken in posteroanterior radiograph of the wrist.
Radial inclination represents the angle between one line connecting the radial styloid tip and the ulnar aspect of the distal radius and a second line perpendicular to the longitudinal axis of the radius.
Radial Inclination
The radial inclination ranges between 21° and 25°.
Radial inclination value would change in fractures of articular surface.
Loss of radial inclination will increase the load across the lunate.
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Palmar Tilt represents the angle between a line joining the dorsal and volar margins of the articular surface and the long axis of the radius on a lateral xray.
Palmar TIlt of Distal Radius
It is also called Volar Angle or Radial Tilt.
The normal palmar tilt averages 11° and has a range of 2°-20°.
It is an important parameter in treatment of distal radius fractures.
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The ultimate treatment goal in fractures of distal radius is a wrist that has sufficient pain-free motion and stability to permit vocational and avocational activities without the propensity for future degenerative changes.
There are certain radiological parameters that would help to achieve these goals.
Intra -articular Incongruity
Congruity of radiocarpal joint remains the most significant radiological parameter for both functional outcome and future degenerative changes.
There is no universal agreement though on how much step in articular step is acceptable because studies have documented increase in stress with step-offs as small as 1 mm. Other studies report worsening of functional outcome if the step is beyond 2mm.
The change in palmar tilt increases the tension on the palmar and dorsal radioulnar ligaments resulting in an increased load required for forearm rotation. Acceptable limit is up to neutralization of the tilt.
Studies have indicated a strong correlation between radial length and loss of strength. More than 2 mm of radial shortening has been reported to result in symptomatic loss of strength. Acceptable radial length is within 2 to 3 mm of the contralateral wrist.
A correlation between decrease in radial inclination and decreased grip strength has been documented and there is increased risk of degenerative changes.Less than 5 degrees of loss is acceptable. [Read more...]
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Several classification systems have been proposed for fractures of distal radius. Here are the major ones used widely
Gartland and Werle
A classification system that assessed the three basic components of these injuries
Fractures are classified into four groups
Group I
Simple Colles’ fracture with no involvement of the radial articular surfaces
Group II
Comminuted Colles’ fractures with intra-articular extension without displacement [Read more...]
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Darrach procedure is removal of distal ulna. It was first performed by Darrach in 1911 in New York City. Darrach Procedure is done for
The procedure is generally performed on elderly patients in whom functional demand is low.
The procedure is performed by dorsal approach by longitudinal incision is made over distal ulna. It involves resection of 1-2 cm of ulna. [Read more...]
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The standard series of posteroanterior, lateral, and oblique x-ray views is useful to visualize a suspected distal radius fracture. However, additional views may be obtained as needed to assess for displacement or additional injuries.
PA View
If fracture is extra-articular [ Does not involve the joint] radial shortening and comminution is noted. In addition if present, location of fracture of ulnar styloid is noted (tip/waist/base).
In case of intra-articular fractures any impacted fragment including depression of the lunate facet is noted [articular surface of distal end radisu for lunate bone] is looked for. Interruption of the proximal carpal row, if any would be visible on this view. [Read more...]
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History
In patients presenting with fracture of distal end of radius, there is often a history of fall on the hand of the involved side. The patient presents with a wrist deformity and swelling of the wrist.
Physical Examination
The majority of the external physical findings seen with fracture of distal end of radius are related to the fact that the fractured radius gets shortened relative to the intact strut of the ulna.
This accounts for the radially deviation and dorsal angulation found in a number of cases [An example of typical Colle's fracture].
Because of dorsal angulation, the palmar portion [on the side of the palm] of the fragment becomes prominent, it might result in displacement of median nerve palmarward. [Read more...]
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From being treated solely in the cast to being operated with a variety of gadgets, fractures distal end of radius have evolved a lot. It represents approximately one-sixth of all fractures treated in emergency departments
Paradigm seems to have changed today.
Modern day studies have shown the need for operative intervention in a growing number of patients. Young age, articular incongruity and functional demands are some guidelines for operative indications in treatment of these fractures.
Distal radius fractures has three main peaks of occurrence. [Read more...]
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34 years old male suffered injury to left wrist and presented to us with swelling. His xrays revealed following picture
Anteroposterior view of Fracture Lower End Radius
As we can see the fracture is quite low and almost near the joint. [Read more...]
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