Metz V M, Gilula L A
Department of Radiology, University of Vienna Medical School, Austria.
Orthop Clin North Am. 1993 Apr;24(2):217-28.
In patients with distal radius fractures, routine roentgenographic examination in at least two or three planes should be performed first and is usually sufficient for correct diagnosis and adequate treatment. A careful examination of the soft tissues of the forearm and wrist on conventional roentgenograms may be key for correct diagnoses. Routine roentgenographic examination of the wrist, preferable in four views, should be performed in every patient with a distal radius fracture acutely as well as at follow-up. The technique is easy to perform, universally available, and inexpensive. Advanced imaging techniques such as radionuclide bone imaging, CT, or MR imaging should not be first choice modalities in patients with distal radius fractures and should be used only when conventional roentgenograms are inconclusive. Scintigraphy can be helpful for diagnosing occult fractures, for documenting fracture healing and ligamentous or cartilaginous post-traumatic disorders, as well as for diagnosis and follow-up of reflex sympathetic dystrophy. A disadvantage of scintigraphy is its poor specificity. Indications for CT include the confirmation of occult fractures suspected on the basis of the findings of physical examination and focally hot bone scintigrams when plain films are normal or inconclusive. In comparison with conventional radiography, CT is superior for the preoperative evaluation of complex comminuted distal radius fractures, depicting the distal radial articular surface and size and position of fracture fragments, as well as for the assessment of fracture healing. Additionally, CT is the imaging technique of choice for the correct diagnosis of subluxations of the distal radioulnar joint. Magnetic resonance imaging is an important diagnostic technique for the evaluation of suspected injuries of soft tissues related to distal radius fractures, such as to the flexor and extensor tendons or the median nerve, and for the early diagnosis of necrosis of the scaphoid or lunate. Other indications include identification of triangular fibrocartilage complex perforations, ruptures of carpal ligaments, and demonstration of contents of the carpal tunnel.
对于桡骨远端骨折患者，应首先至少在两个或三个平面进行常规X线检查，这通常足以进行正确诊断和充分治疗。在传统X线片上仔细检查前臂和腕部的软组织可能是正确诊断的关键。对于每例桡骨远端骨折患者，无论急性期还是随访时，均应进行腕部常规X线检查，最好拍摄四个位置的片子。该技术操作简便、普遍可用且价格低廉。对于桡骨远端骨折患者，放射性核素骨显像、CT或MRI等先进成像技术不应作为首选检查方法，仅在传统X线片诊断不明确时使用。骨闪烁显像有助于诊断隐匿性骨折、记录骨折愈合情况以及韧带或软骨的创伤后疾病，还可用于反射性交感神经营养不良的诊断和随访。骨闪烁显像的一个缺点是特异性较差。CT的适应证包括根据体格检查结果怀疑存在隐匿性骨折，以及平片正常或诊断不明确时骨闪烁显像局部显热的情况。与传统放射摄影相比，CT在复杂粉碎性桡骨远端骨折的术前评估、描绘桡骨远端关节面以及骨折碎片的大小和位置以及评估骨折愈合方面更具优势。此外，CT是正确诊断桡尺远侧关节半脱位的首选成像技术。磁共振成像对于评估与桡骨远端骨折相关的可疑软组织损伤，如屈肌腱和伸肌腱或正中神经损伤以及舟骨或月骨坏死的早期诊断是一项重要的诊断技术。其他适应证包括识别三角纤维软骨复合体穿孔、腕韧带断裂以及显示腕管内容物。
