Diagnosing a Distal Radius Fracture

Physicians usually follow a three-step process to diagnose a distal radius fracture:

Patient history
The physician will ask the patient for a description of symptoms, how they started, and what triggers them.

Physical exam
The wrist and forearm will be examined for dislocation or discoloration. Physicians may also manipulate the wrist or ask patients to perform certain hand or wrist movements, if they are able.

Imaging
This is the most reliable way to diagnose a distal radius fracture. Physicians will almost always order an X-ray exam of the wrist from several angles. They may also use other imaging options under certain circumstances:

• An MRI or CT test can be helpful to examine complex fractures or look for additional injury to nearby soft tissues. MRIs and CTs may be done with injected contrast dye (called MRI-arthrograms and CT-arthrograms) to help show damage to ligaments or other soft tissues.
• A bone scan (scintigraphy) test can detect metabolic changes in bone from fractures, which can be helpful with otherwise hard-to-see bone structures

Imaging will also help determine the classification of the fracture. There are several ways to classify a distal radius fracture, which can have an effect on how it is treated:

• Intra-articular vs. extra-articular—whether the fracture extends into the radiocarpal joint or not
• Displaced vs. nondisplaced—whether the bones or fragments have moved out of place
• Comminuted—whether the bone is fractured or splintered into more than two fragments
• Compound—whether the fracture has broken the skin

Once physicians take into account factors like the age and activity level of the patient and the nature of the fracture, they can determine if the fracture can be reset without surgery (closed reduction) or requires surgery (open reduction).