From the Guidelines
To order a distal radius X-ray, request a "three-view wrist X-ray" with posteroanterior (PA), lateral, and 45 semipronated oblique views, as this is the recommended initial imaging for suspected acute hand and wrist trauma, including distal radius fractures 1. When placing the order, include relevant clinical information such as suspected fracture, pain location, mechanism of injury, and any physical exam findings.
- The standard protocol typically includes these three views to properly visualize the distal radius from different angles, which is essential for accurate diagnosis of fractures, dislocations, or other abnormalities.
- Specify the affected side (left, right, or bilateral) to ensure the correct area is imaged.
- If there's concern about associated injuries, consider ordering additional X-rays of adjacent structures like the hand or forearm.
- A fourth projection—a semisupinated oblique—may also be considered to increase diagnostic yield for distal radius fractures, as reported in one study 1. The distal radius is the most commonly fractured bone in the arm, particularly in older adults with osteoporosis and in younger patients after high-energy trauma, making proper imaging crucial for diagnosis and treatment planning.
- Key considerations when ordering a distal radius X-ray include:
- Ensuring the correct views are included to provide an accurate diagnosis
- Providing relevant clinical information to guide image interpretation
- Considering additional imaging or views as needed to evaluate associated injuries or complex cases.
From the Research
Ordering a Distal Radius X-ray
To order a distal radius X-ray, consider the following steps:
- Determine the mechanism of injury and assess for associated bony or soft tissue injuries and neurovascular symptoms 2
- Evaluate the need for radiographs to assess for intra-articular involvement and fracture displacement 2
- Consider the use of anatomic tilt radiographs to detect screw penetration of the distal radius articular surface 3
- Choose the appropriate imaging modality, such as plain radiographs, fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasonography, depending on the specific needs of the patient 4
Key Considerations
- The British Orthopaedic Association Standards for Trauma and Orthopaedics provide guidelines for the management of distal radius fractures, including the use of radiographs 2
- The optimal duration of immobilization for conservative treatment of distal radius fractures is still debated, but shorter immobilization periods may yield equal or better outcomes 5
- Radiological outcomes, such as pain, grip strength, and range of motion, should be considered when ordering a distal radius X-ray 5
Imaging Modalities
- Plain radiographs and fluoroscopy are the dominant imaging modalities for distal radius fractures 4
- Computed tomography can provide more information about implant placement and articular surface comminution, but exposes patients to higher doses of radiation 4
- Magnetic resonance imaging is less commonly used, but can be useful for occult fractures and other associated injuries 4
- Ultrasonography is gaining popularity for evaluating implant placement and tendon impingement 4