Predictive Power of Distal Radial Metaphyseal Tenderness for Diagnosing Occult Fracture

Steven Z. Glickel, Lauren Hinojosa, Claire M. Eden, Elaine Balutis, O. Alton Barron, Louis W. Catalano

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Purpose To correlate the physical examination finding of distal radial metaphyseal tenderness with plain radiographic and magnetic resonance imaging after acute wrist injury to diagnose occult distal radius fractures. We hypothesized that persistent distal radial metaphyseal tenderness 2 weeks after acute injuries is predictive of an occult fracture. Methods Twenty-nine adult patients presented, after acute trauma, with distal radial metaphyseal tenderness and initial plain radiographs and/or fluoroscopic images that did not show a distal radius fracture. Patients were reevaluated clinically and radiographically at approximately 2 weeks after initial presentation. Patients with persistent distal radial tenderness and negative radiographs underwent magnetic resonance imaging to definitively diagnose an occult distal radius fracture. We calculated the sensitivity and positive predictive value for persistent distal radial metaphyseal tenderness using a 95% confidence interval and standard formulas. Both radiographs and magnetic resonance imaging were used as our endpoint diagnosis for a distal radius fracture. Results We diagnosed 28 occult distal radius fractures, 8 by follow-up radiograph and 20 by magnetic resonance imaging. The positive predictive value for patients who completed the protocol was 96%. One patient who did not have an occult distal radius fracture had a fracture of the ulnar styloid. Conclusions Tenderness of the distal radial metaphysis after wrist injury is strongly suggestive of a distal radius fracture despite both normal plain radiographs and fluoroscopic images. Type of study/level of evidence Diagnostic III.

Original languageEnglish (US)
Pages (from-to)835.e1-835.e4
JournalJournal of Hand Surgery
Issue number10
StatePublished - Oct 2017
Externally publishedYes


  • Distal radius fracture
  • occult fracture
  • radiographic diagnosis
  • trauma
  • wrist

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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