Arthroscopic Management of Scapholunate Dissociation

Abstract

Radial styloid fractures may be relatively simple distal radial fractures or part of an incomplete or complete greater arch perilunate dislocation (Fig. 8.1a) [11]. If it is a part of a perilunate dislocation, all of us are aware about the need to assess and fully treat both the radial and ulnar-sided injuries. It is therefore surprising that we still struggle to identify associated injuries with all other distal radius fractures (Fig. 8.1a–d). These assumptions are supported by the fact that scapholunate (SL) disruptions are more common with displaced partial articular or intra-articular (AO B and C Types) than extra-articular fractures [6]. In fact, the prevalence of SL ligamentous injury in displaced distal radius fractures have been found to be as high as 85%, but also as low as 18% (Fig. 8.2) [9, 12, 16, 18]. The impact of intra-articular fracture distribution is further emphasized by the fact that late presenting symptomatic SL dissociations have been found in patients with arthroscopically-diagnosed grade 3 and 4 SL ligament tears at the time of the fracture (Table 8.1) [3]. Furthermore, there is a fourfold risk of such significant grade 3–4 SL tears with an ulnar variance of >2 mm on the initial radiographs [3].