How badly shattered is this radius?
I (39, male) sustained a comminuted fracture of distal radius, accompanied by a fracture of the ulnar styloid, in a traffic accident—got hit by a motorbike while crossing the road. Everything happened so quickly that I don't remember all the details, but I do believe that the fracture was caused not by the fall (which did follow) but as a result of my putting my hand in front of me and the force of the impact from the moving motorbike traveling axially through the radius (in case it matters).
I know that ideally all the questions below should go to my orthopedist, but since I'm in a foreign country (Vietnam) and the communication I have received so far was very sparse (and not necessarily due to the language barrier: the answers I get somehow always sound purposely vague), I decided I'd try Reddit.
Basically, I was told that I can expect good results with conservative treatment, so currently I'm in a cast. No reduction was done or offered—the arm was casted “as is.” I didn't give it much thought at the time because all of my experience with bone fractures comes from my childhood when the fractures were treated conservatively and everything turned out to be fine. However, I eventually started doing my research into bone fractures in adults and found out that it's much more common to fix them surgically as you can’t expect adult bones to fix slight malunion like growing bones do on their own. Naturally, I began to doubt whether conservative treatment was the right choice.
I asked local orthopedists to look at my x-rays and CT scans and tell me what my radial height, radial inclination, or volar tilt were. But like I said, I only got vague answers like "it's there"— which seems to be a very strange thing to say, because arguably anybody who has a radius has radial inclination. What I'd like to know is what it is exactly (the angle), and if there's a loss, then whether that loss is acceptable for the wrist function to be preserved. Same with the other 2 parameters, but all I hear is that it's all ok.
I have attached a series of images. The first three are the x-rays. The first image are the two views of the same x-ray taken on the day I sustained the injury. Pictures 2 and 3 were taken three weeks later. While the contours of the bones seem relatively preserved on the PA view, I circled in red the area of the radius where it seems to me that the fragment has shifted on the lateral views. It seems to me that there is a definite loss of volar tilt caused by this, but then again I have read that the tilt varies widely between individuals, and I don't know what it was in my case before the injury.
Then there is a series of images that I extracted from two different DICOM viewers. The first one, white and yellow, is from the first CT scan done the day after the injury. I removed the wrist bones for a better view, but the ulna remains. All the others are from the second CT (9 days after the incident), and I removed the wrist bones and the ulna to have a good view of all the possible angles of the radius. And what's strange about all of those images is that, the fracture lines aside, it seems that there are parts of the radius that are simply missing (looks like voids in the bone), especially around the lunate fossa and Lister's tubercle. What happened there? Was the bone simply shattered, or did the reduced bone density not allow the machine to pick it up?
The last three images were found in the folders inside the 2 DICOM files titled Key. The first image is from the first CT scan, the other two are from the second.
I'm not a professional, and I don't know how to interpret most of this. But I know that there are some medical professionals in this group—as well as regular people who know more about bone fractures and radiological images than I do. So my question is: is the loss, if any, of radial inclination, radial height, and volar tilt acceptable in my case? Should this fracture be treated surgically or conservatively? And how much of my wrist function can I expect to regain if I continue with the conservative treatment?
Posted Aug 13, 2025, 11:29 PM UTC