From the Guidelines
CT scans are not routinely necessary for all intra-articular distal radius fractures, but they are often recommended for complex cases to guide treatment decisions. When the initial radiographs are equivocal, CT without IV contrast is commonly used to exclude or confirm suspected wrist fractures, as it shows intra-articular extension of distal radius fractures more frequently than radiography 1. The use of CT scans in intra-articular distal radius fractures is particularly helpful in preoperative planning for complex articular injuries, as three-dimensional reconstructions can provide valuable information for surgeons 1.
Key Considerations
- Initial evaluation should include standard radiographs (posteroanterior, lateral, and oblique views), which are sufficient for many fractures.
- CT scanning should be considered when there is uncertainty about fracture pattern complexity, when multiple articular fragments are present, when the extent of articular involvement is unclear, or when surgical intervention is being planned.
- CT provides superior visualization of articular step-offs, gaps, comminution patterns, and small fragments that may not be apparent on plain radiographs, helping surgeons determine the optimal fixation strategy, surgical approach, and need for bone grafting 1.
Decision-Making
The decision to obtain a CT scan should be individualized based on fracture characteristics, patient factors, and treatment goals. For simple intra-articular fractures with minimal displacement, CT may not add significant value, while for complex fractures with significant comminution or displacement, CT can be essential for proper management and may improve surgical outcomes by allowing for more precise preoperative planning. As noted in the study by Torabi et al, published in the Journal of the American College of Radiology in 2019, CT is useful in diagnosing injuries that are difficult to recognize on radiographs, such as carpometacarpal joint fracture dislocations 1.
From the Research
Intra-Articular Distal Radius Fractures and CT Scans
- Intra-articular distal radius fractures often require accurate evaluation to determine the best course of treatment, and Computed Tomography (CT) scans can play a crucial role in this process 2, 3, 4, 5.
- CT scans can provide more detailed information about the fracture, including the extent of articular surface depression, comminution, and involvement of the distal radioulnar joint, which can influence treatment plans 2, 3, 4.
Advantages of CT Scans
- CT scans can improve the sensitivity of measurement of articular surface gapping and the accuracy of detection of comminution and distal radioulnar joint involvement 2, 3.
- CT scans can also provide more reproducible values for determining step and gap displacement compared to plain radiographs 3.
- The use of CT scans can alter proposed treatment plans and improve interobserver reliability in the management of intra-articular distal radius fractures 2, 4, 5.
Specific Fracture Patterns
- Fracture lines of distal radial intraarticular 2-part fractures tend to propagate through the cortical bone between ligament origins and do not involve Lister's tubercle 6.
- Three major fracture patterns have been identified: radial styloid, dorsal, and volar, each with two subtypes 6.
- The involvement of the distal radioulnar joint is common, and surgical intervention may be beneficial in cases with remarkable intra-articular displacement 5.
Recommendations for CT Scan Use
- CT scans are recommended for patients who are surgical candidates for open reduction and internal fixation or when more information about the extent of comminution and joint depression is required 4.
- The use of CT scans can aid in the classification of fracture patterns and the magnitude of displacement in the distal radioulnar joint, which can inform treatment decisions 5.