Upper limb

Wrist radiograph — distal radial fracture

Plain radiograph · Posteroanterior and lateral wrist · Wrist

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You met this bone at the osteology bench; here it is on a film. The reason the deformity has a name is anatomical: the distal fragment tilts dorsally, so the wrist takes the shape of a dinner fork from the side. Before you say anything about the fracture, name the carpal rows and check the radial styloid, because that relationship is what surgeons restore.

$Wrist radiograph — distal radial fracture — Plain radiograph, Posteroanterior and lateral wrist$

Plain radiograph · Posteroanterior and lateral wrist · © MedpulseIq.com

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Name the anatomy first

The distal radius and ulna and their articular surfaces
The proximal carpal row — scaphoid, lunate, triquetral and pisiform
The distal carpal row — trapezium, trapezoid, capitate and hamate
The normal downward projection of the radial styloid below the ulnar styloid

Do not confuse it with

A Smith fracture
In a Smith fracture the distal fragment displaces towards the palm rather than the back of the wrist, giving the reverse deformity.
A scaphoid fracture
Tenderness and the fracture line lie in the anatomical snuffbox and the scaphoid waist; the distal radial cortex is intact.

Examiner trap

Reporting the radius and stopping. The scaphoid and the distal radio-ulnar joint must be commented on, because both are commonly injured with it.

Memory hook

Dorsal tilt makes a dinner fork; palmar tilt makes it a Smith.

Senior’s 30-second takeaway

Wrist radiograph — distal radial fracture — the whole bench in four lines. Read this on the way in.

If you see this: Two wrist views with soft-tissue swelling · A cortical break in the distal radius · Dorsal tilt of the distal fragment on the lateral
If asked to identify it: There is a fracture of the distal radius with dorsal displacement of the distal fragment.
If asked one more: The radial styloid normally lies about a centimetre distal to the ulnar styloid.
If asked why it matters: Always check the distal radio-ulnar joint and exclude a scaphoid fracture as well.

Then stop. Let the examiner ask the next question.

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Senior’s 30-second takeaway

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