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Comparisons of three radiographic views in assessing for scapholunate instability

  • Surgery Articles
  • Published:
HAND

Abstract

Background

Multiple wrist x-ray images have been described to assess for scapholunate (SL) instability. Some views may be redundant. The purpose of this study was to compare three plain x-ray views in identifying a traumatic diastasis of the SL interval.

Methods

Nineteen patients (19 wrists) with a positive scaphoid shift test and surgically confirmed SL ligament damage were identified. There were 15 males and 4 females with a mean age of 39 years. Pre-operative x-rays were reviewed, including posteroanterior (PA) neutral and PA ulnar deviation views of the injured wrist, and PA clenched fist views of the injured and uninjured wrists. Dynamic SL instability was defined by an SL mid-interval gap of <3 mm and static SL instability by a gap of ≥3 mm in the PA neutral views. The mid-interval measurements were compared between x-ray images.

Results

There were 10 dynamic and 9 static SL instability cases. The PA ulnar deviation and the PA clenched fist views showed significantly greater SL gaps in comparison to the PA neutral views in dynamic but not static SL instability cases. In both categories of instability, there was no significant difference in the SL gaps between the two stress images. The PA clenched fist view of the uninjured wrist revealed SL gapping of >3 mm in 50% of patients but with generally greater gapping in the clenched fist view of the injured wrist.

Conclusions

The PA ulnar deviation and clenched fist stress views were equally effective in showing a dynamic SL diastasis following wrist injury. Neither view was more effective than a neutral PA view in diagnosing static SL instability.

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Grant Support

None.

Conflict of Interest

Ronak M. Patel declares that he has no conflict of interest.

David M. Kalainov has received consulting fees from Acumed and Skeletal Kinetics unrelated to this study.

Brian J. Chilelli declares that he has no conflict of interest.

Richard L. Makowiec has received consulting fees from Skeletal Kinetics unrelated to this study.

Statement of Human and Animal Rights

This article does not contain any studies with human or animal subjects. Nevertheless, all potentially applicable procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as reviewed in 2008. Approval was obtained for this study from the Institutional Review Board of Northwestern University.

Statement of Informed Consent

Informed patient consent was waived by the Institutional Review Board of Northwestern University given the retrospective design of the study with no patient interaction or published personal identifying information.

Funding Received

We received no funding directly or indirectly related to this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 1350, Chicago, IL, 60611, USA

    Ronak M. Patel, David M. Kalainov & Brian J. Chilelli

  2. Cadence Physician Group Orthopaedics, 27650 Ferry Road, Suite 100, Warrenville, IL, 60555, USA

    Richard L. Makowiec

  3. Northwestern Center for Surgery of the Hand, 737 N. Michigan Ave., Suite 700, Chicago, IL, 60611, USA

    David M. Kalainov

Authors
  1. Ronak M. Patel
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  2. David M. Kalainov
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  3. Brian J. Chilelli
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  4. Richard L. Makowiec
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Correspondence to David M. Kalainov.

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Patel, R.M., Kalainov, D.M., Chilelli, B.J. et al. Comparisons of three radiographic views in assessing for scapholunate instability. HAND 10, 233–238 (2015). https://doi.org/10.1007/s11552-014-9695-x

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  • DOI: https://doi.org/10.1007/s11552-014-9695-x

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