title: A structured review addressing the use of radiographic measures of alignment and the definition of acceptability in patients with distal radius fractures.
abstract: BACKGROUND
  Standard radiographs are routinely used in clinical care to characterize the severity of a distal radius fracture and to monitor patients following a distal radius fracture. The objective of this review was to describe the range and variability of radiographic measures described in the literature in patients following a distal radius fracture.
  
  
  METHODS
  A structured literature review was conducted using the Embase and PubMed databases. Inclusion criteria included full-text publications which employed radiographic measures to examine 100 or more participants following a distal radius fracture. A standardized data extraction form was used to identify study design, fracture classification systems, the types of and definitions of radiographic measurements, and acceptability criteria following distal radius fractures.
  
  
  RESULTS
  From an initial 263 studies, 31 studies were included in the final data extraction process. A narrative synthesis of the articles included in this review indicated that there was a set of commonly used radiographic measurements examined in patients with a distal radius fracture which included radial inclination, volar/dorsal tilt, intra-articular step/gap, and a measure of ulnar variance/radial shortening. While 52 % of studies referenced or published a standardized measurement technique, there was substantial variability in the actual description of each radiographic measurement performed.
  
  
  CONCLUSIONS
  Substantial variability in how radiographic measurements are defined in large clinical studies as seen in this review suggest a need for consensus on the assessment and interpretations of radiographic measures used in patients following a distal radius fracture. Guidelines for radiographic measures should be established to ensure consistency between research and treatment centers.
authors.affiliation: Clinical Research Laboratories, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Healthcare London, London, Ontario Canada ; School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario Canada.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Lalone
authors.affiliation: Clinical Research Laboratories, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Healthcare London, London, Ontario Canada ; The University of Western Ontario, London, Ontario Canada.
authors.forename: Ruby
authors.initials: R
authors.lastname: Grewal
authors.affiliation: Clinical Research Laboratories, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Healthcare London, London, Ontario Canada ; The University of Western Ontario, London, Ontario Canada.
authors.forename: Graham J W
authors.initials: GJ
authors.lastname: King
authors.affiliation: Clinical Research Laboratories, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Healthcare London, London, Ontario Canada ; School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario Canada ; The University of Western Ontario, London, Ontario Canada.
authors.forename: Joy C
authors.initials: JC
authors.lastname: MacDermid
keywords: Alignment; Distal radius; Fractures; Radiographic; Structured review; X-ray