Distal radius fracture - occult

Case contributed by Henry Knipe


Wrist pain post fall.

Patient Data

Age: 45 years
Gender: Female

No fracture identified. No dislocation. 

An MRI was performed as there was a high clinical suspicion of fracture (in particular, scaphoid fracture). 

Undisplaced distal radius fracture with intra-articular extension. Minimal radiocarpal effusion. No periosteal hematoma. Alignment within normal limits. 

Case Discussion

In retrospect, there is cortical disruption to the dorsal distal radius but there is overlap with the distal ulna making this a little tricky to see. There are no helpful clues in the soft tissues either:

  • no radiocarpal soft tissue swelling
  • pronator quadratus fat pad is preserved
  • scaphoid fat pad is preserved
  • normal alignment

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