Editing Distal radius fracture (section)

==Diagnosis==
[[File:Displaced distal radius fracture.jpg|thumb|X-ray of a displaced intra-articular distal radius fracture in an external fixator: The articular surface is widely displaced and irregular.]]
Diagnosis may be evident clinically when the distal radius is deformed, but should be confirmed by [[X-ray]].
The [[differential diagnosis]] includes [[scaphoid fracture]]s and wrist dislocations, which can also co-exist with a distal radius fracture. Occasionally, fractures may not be seen on X-rays immediately after the injury. Delayed X-rays, [[X-ray computed tomography]] (CT scan), or [[Magnetic resonance imaging]] (MRI) can confirm the diagnosis.{{citation needed|date=October 2020}}

===Medical imaging===
[[File:Dorsal tilt of distal radius fracture.jpg|thumb|Fracture with a dorsal tilt: Dorsal is left, and volar is right in the image.]]
X-ray of the affected wrist is required if a fracture is suspected. Posteroanterior, lateral, and oblique views can be used together to describe the fracture.<ref name="Court-Brown 2015"/> X-ray of the uninjured wrist should also be taken to determine if any normal anatomic variations exist before surgery.<ref name="Court-Brown 2015"/>

A CT scan is often performed to further investigate the articular anatomy of the fracture, especially for fracture and displacement within the distal radio-ulnar joint.<ref name="Court-Brown 2015"/>

Various kinds of information can be obtained from X-rays of the wrist:<ref name="Court-Brown 2015"/>

'''Lateral view'''
* '''Carpal malalignment''' - A line is drawn along the long axis of the [[capitate]] bone and another line is drawn along the long axis of the radius. If the carpal bones are aligned, both lines will intersect within the carpal bones. If the carpal bones are not aligned, both lines will intersect outside the carpal bones. Carpal malignment is frequently associated with dorsal or volar tilt of the radius and will have poor grip strength and poor forearm rotation.<ref name="Court-Brown 2015"/>
* '''Tear drop angle''' - It is the angle between the line that pass through the central axis of the volar rim of the lunate facet of the radius and the line that pass through the long axis of the radius. Tear drop angle less than 45 degrees indicates displacement of lunate facet.<ref name="Court-Brown 2015"/>
* '''Antero-posterior distance''' (AP distance) - Seen on lateral X-ray, it is the distance between the dorsal and volar rim of the lunate facet of the radius. The usual distance is 19&nbsp;mm.<ref name="Court-Brown 2015"/> Increased AP distance indicates the lunate facet fracture.<ref>{{cite journal|last1=Medoff|first1=RJ|title=Essential radiographic evaluation for distal radius fractures|journal=Hand Clinics|date=August 2005|volume=21|issue=3|pages=279–288|doi=10.1016/j.hcl.2005.02.008|pmid=16039439|s2cid=23616301 }}</ref>
* '''Volar or dorsal tilt''' - A line is drawn joining the most distal ends of the volar and dorsal side of the radius. Another line perpendicular to the longitudinal axis of the radius is drawn. The angle between the two lines is the angle of volar or dorsal tilt of the wrist. Measurement of volar or dorsal tilt should be made in true lateral view of the wrist because [[pronation]] of the forearm reduces the volar tilt and supination increases it. When dorsal tilt is more than 11 degrees, it is associated with loss of grip strength and loss of wrist flexion.<ref name="Court-Brown 2015"/>

'''Posteroanterior view'''
* '''Radial inclination''' - It is the angle between a line drawn from the radial styloid to the medial end of the articular surface of the radius and a line drawn perpendicular to the long axis of the radius. Loss of radial inclination is associated with loss of grip strength.<ref name="Court-Brown 2015"/>
* '''Radial length''' - It is the vertical distance in millimetres between a line tangential to the articular surface of the ulna and a tangential line drawn at the most distal point of radius ([[radial styloid]]). Shortening of radial length more than 4mm is associated with wrist pain.<ref name="Court-Brown 2015"/>
* '''Ulnar variance''' - It is the vertical distance between a horizontal line parallel to the articular surface of the radius and another horizontal line drawn parallel to the articular surface of the ulnar head. Positive ulnar variance (ulna appears longer than radius) disturbs the integrity of triangular fibrocartilage complex and is associated with loss of grip strength and wrist pain.<ref name="Court-Brown 2015"/>

'''Oblique view'''
* Pronated oblique view of the distal radius helps to show the degree of comminution of the distal end radius, depression of the radial styloid, and confirming the position the screws at the radial side of the distal end radius. Meanwhile, a supinated oblique view of shows the ulnar side of the distal radius, accessing the depression of dorsal rim of the lunate facet, and the position of the screws on the ulnar side of the distal end radius.<ref name="Court-Brown 2015"/>

===Classification===
{{Main|Classification of distal radius fractures}}
There are many classification systems for distal radius fracture. AO/OTA classification is adopted by Orthopaedic Trauma Association and is the most commonly used classification system. There are three major groups: A—extra-articular, B—partial articular, and C—complete articular which can further subdivided into nine main groups and 27 subgroups depending on the degree of communication and direction of displacement. However, none of the classification systems demonstrate good liability. A qualification modifier (Q) is used for associated ulnar fracture.<ref name="Court-Brown 2015"/>

For children and adolescents, there are three main categories of fracture: [[Torus fracture|buckle (torus) fractures]], [[greenstick fracture]]s, and complete (or off-ended) fractures.<ref name="Handoll et al 2018"/> Buckle fractures are an incomplete break in the bone that involves the cortex (outside) of the bone. Buckle fractures are stable and are the most common type.<ref name="Handoll et al 2018"/> Greenstick fractures are a bone that is broken only on one side and the bone bows to the other side.<ref name="Handoll et al 2018"/> Greenstick fractures are unstable and often occur in younger children. Complete fractures, where the bone is completely broken, are unstable. In a complete fracture the bone can be misaligned.<ref name="Handoll et al 2018"/> For a complete fracture, a [[closed fracture]]s are those in which the skin and tissue lying over the bone is intact. An [[open fracture]] (exposed bone) is a serious injury.<ref name="Handoll et al 2018"/>