X-ray of a displaced intra-articular<unk>  in an external fixator: The articular surface is widely displaced and irregular. Diagnosis may be evident clinically when the<unk><unk>  is deformed, but should be confirmed by X-ray. The differential diagnosis includes scaphoid fractures and wrist dislocations, which can also co-exist with a<unk> . Occasionally, fractures may not be seen on X-rays immediately after the injury. Delayed X-rays, X-ray computed tomography (CT scan), or Magnetic resonance imaging (MRI) can confirm the diagnosis. Medical imaging Fracture with a dorsal tilt: Dorsal is left, and volar is right in the image. X-ray of the affected wrist is required if a fracture is suspected. Posteroanterior, lateral, and oblique views can be used together to describe the fracture. X-ray of the uninjured wrist should also be taken to determine if any normal anatomic variations exist before surgery. A CT scan is often performed to further investigate the articular anatomy of the fracture, especially for fracture and displacement within the<unk>  radio-ulnar joint. Various kinds of information can be obtained from X-rays of the wrist: Lateral view * Carpal malalignment - A line is drawn along the long axis of the capitate bone and another line is drawn along the long axis of the<unk> . If the carpal bones are aligned, both lines will intersect within the carpal bones. If the carpal bones are not aligned, both lines will intersect outside the carpal bones. Carpal malignment is frequently associated with dorsal or volar tilt of the<unk>  and will have poor grip strength and poor forearm rotation. * Tear drop angle - It is the angle between the line that pass through the central axis of the volar rim of the lunate facet of the<unk>  and the line that pass through the long axis of the<unk> . Tear drop angle less than 45 degrees indicates displacement of lunate facet. * Antero-posterior<unk> ce (AP<unk> ce) - Seen on lateral X-ray, it is the<unk> ce between the dorsal and volar rim of the lunate facet of the<unk> . The usual<unk> ce is 19 mm. Increased AP<unk> ce indicates the lunate facet fracture. * Volar or dorsal tilt - A line is drawn joining the most<unk>  ends of the volar and dorsal side of the<unk> . Another line perpendicular to the longitudinal axis of the<unk>  is drawn. The angle between the two lines is the angle of volar or dorsal tilt of the wrist. Measurement of volar or dorsal tilt should be made in true lateral view of the wrist because pronation of the forearm reduces the volar tilt and supination increases it. When dorsal tilt is more than 11 degrees, it is associated with loss of grip strength and loss of wrist flexion. Posteroanterior view * Radial inclination - It is the angle between a line drawn from the radial styloid to the medial end of the articular surface of the<unk>  and a line drawn perpendicular to the long axis of the<unk> . Loss of radial inclination is associated with loss of grip strength. * Radial length - It is the vertical<unk> ce in millimetres between a line tangential to the articular surface of the ulna and a tangential line drawn at the most<unk>  point of<unk>  (radial styloid). Shortening of radial length more than 4mm is associated with wrist pain. * Ulnar variance - It is the vertical<unk> ce between a horizontal line parallel to the articular surface of the<unk>  and another horizontal line drawn parallel to the articular surface of the ulnar head. Positive ulnar variance (ulna appears longer than<unk>  disturbs the integrity of triangular fibrocartilage complex and is associated with loss of grip strength and wrist pain. Oblique view * Pronated oblique view of the<unk><unk>  helps to show the degree of comminution of the<unk>  end<unk> , depression of the radial styloid, and confirming the position the screws at the radial side of the<unk>  end<unk> . Meanwhile, a supinated oblique view of shows the ulnar side of the<unk><unk> , accessing the depression of dorsal rim of the lunate facet, and the position of the screws on the ulnar side of the<unk>  end<unk> . Classification There are many classification systems for<unk> . AO/OTA classification is adopted by Orthopaedic Trauma Association and is the most commonly used classification system. There are three major groups: A—extra-articular, B—partial articular, and C—complete articular which can further subdivided into nine main groups and 27 subgroups depending on the degree of communication and direction of displacement. However, none of the classification systems demonstrate good liability. A qualification modifier (Q) is used for associated ulnar fracture. For children and adolescents, there are three main categories of fracture: buckle (torus) fractures, greenstick fractures, and complete (or off-ended) fractures. Buckle fractures are an incomplete break in the bone that involves the cortex (outside) of the bone. Buckle fractures are stable and are the most common type. Greenstick fractures are a bone that is broken only on one side and the bone bows to the other side. Greenstick fractures are unstable and often occur in younger children. Complete fractures, where the bone is completely broken, are unstable. In a complete fracture the bone can be misaligned. For a complete fracture, a closed fractures are those in which the skin and tissue lying over the bone is intact. An open fracture (exposed bone) is a serious injury.
Distal radius fracture
Scaphoid fracture
Elbow fracture
Humerus fracture
Ulna fracture
Scapular fracture
Jefferson fracture
Bosworth fracture