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Advanced Imaging in Distal Radius Fractures


Key Points

  • CT scan can allow for improved identification of intraarticular fracture fragments in distal radius fractures.

  • Use of CT scan for preoperative planning can allow for improved guidance of fracture fragment fixation intraoperatively.

  • Utilization of CT in association with 3D printing can allow for improvement in the surgical treatment of distal radius malunions.

  • Currently available 3D CT reconstruction technology has significant limitations as it is only a 2D projection of the 3D data set. True 3D modeling allows for virtual preoperative planning and can provide invaluable information to the surgeon.

Conflict of Interest

Associate Professor Sandow has been involved in the development of interactive 3D imaging ( www.truelifeanatomy.com.au and www.rubamas.com ) and has a potential conflict of interest in the subject of the paper.

Panel 1: Case Scenario

A 48 year-old, right-handed female visited the emergency department with a right wrist deformity after a fall on the outstretched hand. Radiographs shows an intraarticular distal radius fracture with 25 degrees of dorsal angulation and dorsal metaphyseal as well as intraarticular comminution ( Fig. 1 A–C ). What is the most effective approach to preoperative planning for this fracture?

Fig. 1, Injury PA (A), oblique (B), and lateral (C) radiograph of a 48-year-old female with an intraarticular distal radius fracture.

Importance of the Problem

Distal radius fractures are a common injury, and diagnosis of fracture patterns and stability are critical factors in the management of these fractures. Identification of fracture patterns in intraarticular fractures can affect the determination of optimal fixation technique. Preoperative computed tomography (CT) can aid in the identification of intraarticular fracture patterns and guide treatment. CT can also be a beneficial adjunct in the treatment of distal radius malunion correction, especially when combined with 3D modalities.

Confusion over the functionality of the various forms of 3D imaging has created challenges in expanding the use of such technology, with cost, time, and access convenience being potential issues. Sandow has detailed some of the technical aspects of both volume rendering (which is the predominant 3D modality in medical CT) and surface rendering (which is the predominant 3D modality use outside of the field of medicine).

3D printing technology is an advanced preoperative planning tool that can be utilized to decrease operative time, blood loss, and fluoroscopy use ( Fig. 2 ). However, improved surgeon access to computer based digital 3D simulation may improve the contribution and utility of such advanced imaging techniques to improve preoperative planning, implant selection, and optimal technique in malunion correction.

Fig. 2, Example of a 3D printed model of a comminuted articular fracture.

Main Question

What is the utility of advanced imaging techniques in the diagnosis, preoperative planning, and treatment of distal radius fractures?

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