Colles/DRF Adequacy Post M&R

Volar Tilt Lateral view:
- angle between:

• one line: along distal radial articular surface
• another line: perpendicular to the radial longitudinal axis at the joint margin

Radial Inclination/Angle (15-25): PA view
- angle between:

• one line: connecting the radial styloid tip and ulnar aspect of the distal radius
• second line: perpendicular to the longitudinal axis of the radius

* loss of radial inclination will increase the load across the lunate; difficulty on wrist flexion

Radial height/length/positive (9-12): PA view
- distance between:

• one line: perpendicular to the long axis of the radius passing through the distal tip of radial styloid
• second line: perpendicular to the long axis of the radius passing through distal articular surface of the ulnar head

Normal values (Rosen's):
RI: 15-25 degrees
RH: 9-12 mm
VT: 10-25 degrees

Indications for Reduction: any of these

	Rosen’s	IFSSH*
Volar Tilt	<0°	< -10° (or >10° Dorsal tilt)
Radial Height Shortening	>2mm	>5mm (vs contralateral wrist)
Radial Inclination	<15°	<15°
Intra-articular step-off	>1mm	>2mm

*IFSSH: International Federation of Societies for Surgery of the Hand – through International Distal Radial Fracture Study Group (link)

mnemonic: SHTI-Step-off/Height/Tilt/Inclination: 2-5-10-15

Acceptable Reduction Criteria for Healing

	IFSSH	Graham**
Tilt	<20° volar, <10°dorsal	Between 20° volar & 15° dorsal
Radial Height Shortening	<5mm	<5mm (vs contralat wrist)
Radial Inclination	>10°	≥15°
Intra-articular step-off	<2mm	≤2 mm
Articular incongruity of sigmoid notch***	<2mm

** J Am Acad Orthop Surg. Oct 1997;5(5):270-81.
*** Sigmoid notch is the notch/articular surface of the distal radius where the distal ulnar articulates

*Avoid Cotton-Loder position (marked wrist flexion and ulnar deviation) when immobilising

Sources:

Rosen's

radiologyassistant.nl

Emedicine

Graham

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More angles:
1. Scapholunate angle 30-60 degrees: between long axis of scaphoid and lunate at lateral view
2. Capitulolunate angle 0-30 degrees: between capitate and lunate on lateral view
3. Concavity of radius and lunate -- and convexity of capitate: less than 10 degrees