Radial height is the distance between two parallel lines perpendicular to the long axis of the radius. Three measurements on PA films allow for characterization of the injury: radial height, radial inclination, and palmar (volar) tilt PA radiographs allow for evaluation of the integrity of the distal radio-ulnar joint, the radiocarpal joint, the proximal carpal row, and the radial and ulnar styloid processes. All three radiographs should be examined for a loss of normal anatomy, disruption of the articular surface, involvement of the distal radio-ulnar and radiocarpal joints, and evidence of comminution. PA, lateral, and oblique radiographs of the distal radius that include the carpal bones should be obtained. (The latter three should remind you of the rule "Always assess the joints above and below the known injury.") Acute carpal tunnel syndrome (characterized by weakness or loss of thumb or index finger flexion, tingling or alterations of sensation in the median distribution).Physical examination (and imaging) should assess for the following: This information can alert the clinician to the presence of associated injuries (in the case of high energy mechanisms, such as motor vehicle accidents) or the presence of osteoporosis (in the case of low energy mechanisms, such as a fall from a standing height). History-taking should focus on the mechanism of injury and amount of energy involved. The deformity that results from the Colles’ fracture is described as a “dinner fork" deformity because of depression at the fracture site, dorsal angulation, and dorsal displacement of the distal radius. He or she will complain of wrist pain and swelling.
This makes fractures more likely, especially in patients with decreased bone mineral density.Ī patient with a fracture of the distal metaphysis of the radius typically describes falling on an outstretched hand or sustaining a direct blow to the wrist. The distal metaphysis of the radius is therefore a relative weak point. On the lateral side of the radius is a styloid process, onto which the brachioradialis inserts and from which the radial collateral ligament of the wrist originates.Īt the distal metaphysis of the radius, the cortex of the bone is thinner than the bone proximal and distal, and the relative amount of cancellous bone increases. The distal ulna attaches to a meniscus-like structure, the triangular fibrocartilage discus, which can be torn with wrist fractures. There, the radius articulates with the proximal row of carpal bones (allowing flexion and extension) it also articulates with the distal ulna (creating a joint for pronation and supination).
The distal radius forms the proximal side of the wrist joint.
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