Imaging techniques for distal radius fractures and related injuries

In patients with distal radius fractures, routine roentgenographic examination in at least two or three planes should be performed first and is usually sufficient for correct diagnosis and adequate treatment. A careful examination of the soft tissues of the forearm and wrist on conventional roentgenograms may be key for correct diagnoses. Routine roentgenographic examination of the wrist, preferable in four views, should be performed in every patient with a distal radius fracture acutely as well as at follow-up. The technique is easy to perform, universally available, and inexpensive. Advanced imaging techniques such as radionuclide bone imaging, CT, or MR imaging should not be first choice modalities in patients with distal radius fractures and should be used only when conventional roentgenograms are inconclusive. Scintigraphy can be helpful for diagnosing occult fractures, for documenting fracture healing and ligamentous or cartilaginous post-traumatic disorders, as well as for diagnosis and follow-up of reflex sympathetic dystrophy. A disadvantage of scintigraphy is its poor specificity. Indications for CT include the confirmation of occult fractures suspected on the basis of the findings of physical examination and focally hot bone scintigrams when plain films are normal or inconclusive. In comparison with conventional radiography, CT is superior for the preoperative evaluation of complex comminuted distal radius fractures, depicting the distal radial articular surface and size and position of fracture fragments, as well as for the assessment of fracture healing. Additionally, CT is the imaging technique of choice for the correct diagnosis of subluxations of the distal radioulnar joint. Magnetic resonance imaging is an important diagnostic technique for the evaluation of suspected injuries of soft tissues related to distal radius fractures, such as to the flexor and extensor tendons or the median nerve, and for the early diagnosis of necrosis of the scaphoid or lunate. Other indications include identification of triangular fibrocartilage complex perforations, ruptures of carpal ligaments, and demonstration of contents of the carpal tunnel.