Reduction criteria for Distal end radius fractures
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Here is a complete, textbook-based summary of the reduction criteria for distal end radius fractures.
Reduction Criteria for Distal End Radius Fractures
Normal Radiographic Anatomy (the "11-22-11" rule)
These are the baseline values you are trying to restore:
| Parameter | Normal Value |
|---|---|
| Radial height (radial length) | 11-12 mm |
| Radial inclination | 22-23 degrees |
| Volar tilt | 11-12 degrees |
| Ulnar variance | ±2 mm |
Radiographic Measurements - How to Take Them
The three key radiographic measurements are shown in the X-ray below:
- Radial height (A): Distance on PA view between two parallel lines perpendicular to the radial shaft - one at the distal ulnar head, one at the radial styloid. Average 11-12 mm (normal range 8-18 mm).
- Radial inclination (B): Angle on PA view between a line perpendicular to the radial shaft and a line from the DRUJ to the radial styloid. Average 22-23 degrees (normal range 12-30 degrees).
- Volar tilt (C): Angle on true lateral view between a line perpendicular to the radial shaft and a line connecting the volar and dorsal rims of the distal radius. Average 11-22 degrees (normal range 0-28 degrees).
Criteria for Acceptable Reduction (Campbell's Operative Orthopaedics, 15th Ed.)
| Criterion | Normal | Acceptable |
|---|---|---|
| Ulnar variance (radial length) | ±2 mm (lunate facet vs. ulnar head) | No more than 2 mm shortening relative to ulnar head |
| Radial height | 12 mm | Less than 3 mm shortening |
| Palmar (volar) tilt | 11 degrees of volar tilt | Less than 10 degrees of dorsal tilt |
| Radial inclination | 20 degrees (lunate facet to radial styloid) | No less than 10 degrees |
| Intraarticular step or gap | None | Less than 2 mm of either |
Graham's Criteria for Acceptable Healing (Campbell's Operative Orthopaedics, 15th Ed.)
A broader set of criteria used to assess healed fractures and define malunion:
| Criterion | Acceptable Measurement |
|---|---|
| Radioulnar length | Radial shortening <5 mm at DRUJ compared with contralateral wrist |
| Radial inclination | ≥15 degrees on PA film |
| Radial tilt (sagittal) | Between 15 degrees dorsal tilt and 20 degrees volar tilt |
| Articular incongruity | ≤2 mm at radiocarpal joint |
Miller's Review - Quick Summary (Acceptable Reduction)
- Radial shortening: <3 mm
- Dorsal tilt: <10 degrees
- Intraarticular step-off: <2 mm
Indications for Surgery (Failure of Acceptable Reduction)
Parameters associated with poor outcome and likely need for operative management:
- Intraarticular step-off >2 mm at radiocarpal joint
- Step-off >1-2 mm at DRUJ
- Dorsal angulation >20 degrees
- Radial inclination <10 degrees
- Loss of sagittal tilt 20-30 degrees
- Radius shortening >6 mm (causes DRUJ dysfunction)
- Fractures with >25-30 degrees of angulation in frontal or sagittal plane
Lafontaine Criteria - Predicting Instability After Reduction
If 3 or more of the following are present on the initial radiograph, secondary displacement despite closed reduction is likely, suggesting the need for operative management:
- Dorsal angulation >20 degrees
- Dorsal comminution
- Intra-articular radiocarpal fracture
- Associated ulna fracture
- Age over 60
Note: Nesbitt et al. later validated these criteria and found age was the strongest single predictor of secondary displacement. MacKenney et al. (reviewing ~4,000 fractures) identified age, ulnar variance, and metaphyseal comminution as the most consistent predictors - and notably, dorsal angulation was not a significant predictor in that study.
Clinical Monitoring Guidance
For fractures treated closed with radiographic features that increase instability risk: weekly radiographs for the first 3 weeks are recommended so early surgical intervention can occur if the fracture displaces unacceptably.
- Campbell's Operative Orthopaedics, 15th Ed. 2026 - Table 62.13
- Rockwood and Green's Fractures in Adults, 10th Ed. 2025
- Miller's Review of Orthopaedics, 9th Ed.
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