Mateusz Gładysz FESSH prep

FESSH prep Imaging Normal radial inclination, effect of forearm rotation on lateral view palmar tilt, the 15° lateral view, rater agreement for articular step and gap, teardrop angle and anteroposterior distance

Radiographic parameters of the distal radius

Last reviewed v1.0

FESSH-070Imaging●○○ basic

Regarding radiographic measurement of the distal radius:

  1. 1.In a reference series of 200 normal adult wrists, radial inclination on the posteroanterior radiograph averaged about 22–23°.

  2. 2.In a reference series of 200 normal wrists, radial height, radial inclination, ulnar variance and volar tilt did not differ significantly between the left and right sides.

  3. 3.In a cadaver study, palmar tilt measured on a 15° lateral view varied less between surgeons than on the conventional lateral view.

  4. 4.The ulnar styloid tip is used as the ulnar reference point when measuring ulnar variance on a posteroanterior wrist radiograph.

  5. 5.Historical outcome studies have established a close correlation between the teardrop angle or anteroposterior distance and clinical outcome after distal radius fracture.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-070
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. In a reference series of 200 normal adult wrists, radial inclination on the posteroanterior radiograph averaged about 22–23°.

    True

    In a reference study of 200 normal wrist radiographs, mean radial inclination was 22.8° (standard deviation 2.4°) and mean radial height 10.7 mm. The authors found their values comparable to Western references; only volar tilt differed, being higher in their Thai population.

    • Chaitantipongse S, Thaveepunsan S, Suwannaphisit S, Teeragananan T. Reference Values for Normal Wrist Parameters in the Thai Population. J Hand Surg Asian Pac Vol. 2026;31(1):20-27. PMID 41508619

  2. 2. In a reference series of 200 normal wrists, radial height, radial inclination, ulnar variance and volar tilt did not differ significantly between the left and right sides.

    True

    In the reference study of 200 normal wrist radiographs, no parameter (radial height, radial inclination, ulnar variance or volar tilt) differed significantly between wrist sides, although all differed between men and women. The series was drawn from a Thai population, whose values were otherwise comparable to Western references except for volar tilt.

    • Chaitantipongse S, Thaveepunsan S, Suwannaphisit S, Teeragananan T. Reference Values for Normal Wrist Parameters in the Thai Population. J Hand Surg Asian Pac Vol. 2026;31(1):20-27. PMID 41508619

  3. 3. In a cadaver study, palmar tilt measured on a 15° lateral view varied less between surgeons than on the conventional lateral view.

    True

    In Johnson and Szabo's cadaver study, measurements on the 15° lateral view varied less between surgeons than on the conventional lateral view (standard deviation 2.1° against 3.6°) and were less affected by forearm rotation (1.0° against 1.6° per 5° of rotation). The authors recommended it routinely for fractures with significant dorsal angulation.

    • Johnson PG, Szabo RM. Angle measurements of the distal radius: a cadaver study. Skeletal Radiol. 1993;22(4):243-6. PMID 8316865

  4. 4. The ulnar styloid tip is used as the ulnar reference point when measuring ulnar variance on a posteroanterior wrist radiograph.

    False

    The measurement uses the distal articular surface of the ulnar head, rather than the styloid tip. With the perpendicular method, a line tangent to that articular surface is compared with the radial reference line.

    • van Leeuwen WF, Oflazoglu K, Menendez ME, Ring D. Negative Ulnar Variance and Kienböck Disease. The Journal of hand surgery. 2016;41(2):214-8. PMID 26686062

  5. 5. Historical outcome studies have established a close correlation between the teardrop angle or anteroposterior distance and clinical outcome after distal radius fracture.

    False

    Medoff describes the teardrop angle, the anteroposterior distance and articular separation as relatively recently recognised parameters that reflect congruency of the articular surface. Because nearly all historical studies did not measure them routinely, their correlation with clinical outcome is still incompletely known.

    • Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005;21(3):279-88. PMID 16039439