Distal radius fracture differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

Distal radius fracture must be differentiated from wrist strain, ligamentous carpal injury such as scapholunate ligament and triangular fibrocartilage complex (TFCC) tear.

Differentiating Distal Radius Fracture from other Diseases

	Symptoms			Physical examination			Imaging
Diseases	Clinical manifestations						Para-clinical findings			Gold standard	Additional findings
	Symptoms			Physical examination			Para-clinical findings
	Pain	Restriction of Movements	Deformity	Tenderness	Decreased Grip Strength	Decreased sensation in course of Median nerve	X-ray	CT scan	MRI
Distal radius fracture	+	+	+	+	+	+/-	Distal fragment displacement Distal fragment angulation Radial shortening	Useful for preoperative surgical planning for patients with complex, multifragmentary fractures.	Useful in diagnosing occult fractures, ligamentous and soft tissue injuries	X-ray
Wrist strain	+	+	–	+	–	–	No evidence of fracture on radiographs	No evidence of fracture on CT	Soft tissue swelling and tear may be seen	MRI
Ligamentous carpal injury	+	+	+/-	+	–	–	No evidence of fracture on radiographs	No evidence of fracture on CT	Swelling and tear of the ligament may be seen	MRI	Most common injury is scapholunate ligament tear with widening of the scapholunate interval. Positive Watson shift test.
Triangular fibrocartilage complex (TFCC) tear	+	+/-	–	+	–	–	No evidence of fracture on radiographs	No evidence of fracture on CT	Swelling and tear of the ligament may be seen	MRI	Wrist arthroscopy can be useful in visualizing and repairing TFCC tear

References

Overview