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Accuracy of simple plain radiographic signs and measures to diagnose acute scapholunate ligament injuries of the wrist

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine the accuracy of common radiological indices for diagnosing ruptures of the scapholunate (SL) ligament, the most relevant soft tissue injury of the wrist.

Methods

This was a prospective diagnostic accuracy study with independent verification of index test findings by a reference standard (wrist arthroscopy). Bilateral digital radiographs in posteroanterior (pa), lateral and Stecher’s projection were evaluated by two independent expert readers. Diagnostic accuracy of radiological signs was expressed as sensitivity, specificity, positive (PPV) and negative (NPV) predictive values with 95 % confidence intervals (CI).

Results

The prevalence of significant acute SL tears (grade ≥ III according to Geissler’s classification) was 27/72 (38 %, 95 % CI 26–50 %). The SL distance on Stecher’s projection proved the most accurate index to rule the presence of an SL rupture in and out. SL distance on plain pa radiographs, Stecher’s projection and the radiolunate angle contributed independently to the final diagnostic model. These three simple indices explained 97 % of the diagnostic variance.

Conclusions

In the era of computed tomography and magnetic resonance imaging, plain radiographs remain a highly sensitive and specific primary tool to triage patients with a suspected SL tear to further diagnostic work-up and surgical care.

Key Points

• Scapholunate ligament (SL) lesions are the most relevant soft tissue wrist injuries.

• Missed and untreated SL ruptures can cause painful and disabling post-traumatic wrist osteoarthritis.

• Reliable threshold values of radiographic indices should prompt further imaging or surgical care.

• Plain radiographs deliver conclusive clinical information if certain hand positions are used.

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Abbreviations

ACCORDS:

ACcuracy of COmmon Radiological tests for Diagnosing SL ligament ruptures

AUC/ROC:

area under the receiving operating characteristics curve

CI:

confidence interval

NPV:

negative predicted value

pa:

posteroanterior

PACS:

Picture Archiving and Communication System

PPV:

positive predicted value

RL:

radiolunate

SD:

standard deviation

SL:

scapholunate

STARD:

Standards for Reporting of Diagnostic Accuracy

References

  1. Kitay A, Wolfe SW (2012) Scapholunate instability: current concepts in diagnosis and management. J Hand Surg [Am] 37:2175–2196

    Article  Google Scholar 

  2. Lee SK, Park J, Baskies M, Forman R, Yildirim G, Walker P (2010) Differential strain of the axially loaded scapholunate interosseus ligament. J Hand Surg [Am] 35:245–251

    Article  Google Scholar 

  3. Pliefke J, Stengel D, Rademacher G, Mutze S, Ekkernkamp A, Eisenschenk A (2008) Diagnostic accuracy of plain radiographs and cineradiography in diagnosing traumatic scapholunate dissociation. Skelet Radiol 37:139–145

    Article  Google Scholar 

  4. Larsen CF, Mathiesen FK, Lindequist S (1991) Measurements of carpal bone angles on lateral wrist radiographs. J Hand Surg 16:888–893

    Article  CAS  Google Scholar 

  5. Megerle K, Pohlmann S, Kloeters O, Germann G, Sauerbier M (2011) The significance of conventional radiographic parameters in the diagnosis of scapholunate ligament lesions. Eur Radiol 21:176–181

    Article  PubMed  Google Scholar 

  6. Abe Y, Doi K, Hattori Y (2008) The clinical significance of the scaphoid cortical ring sign: a study of normal wrist X-rays. J Hand Surg Eur 33:126–129

    Article  CAS  Google Scholar 

  7. Schmitt R, Frohner S, Fodor S, Christopoulos G, Kalb KH (2006) Early radiological diagnostics for scapholunate dissociation (SLD). Radiologe 46:654–663

    Article  CAS  PubMed  Google Scholar 

  8. Nathan R, Blatt G (2000) Rotary subluxation of the scaphoid. Revisited. Hand Clin 16:417–431

    CAS  PubMed  Google Scholar 

  9. Choi R, Raskin KB (2000) Rotatory subluxation of the scaphoid. Bull Hosp Jt Dis 59:197–200

    CAS  PubMed  Google Scholar 

  10. Watson HK, Sorelle J (2009) Dorsal wrist syndrome and rotary subluxation of the scaphoid. In: Slutsky DJ (ed) Principles and practice of wrist surgery. Saunders, Philadelphia, PA, pp 487–491

    Google Scholar 

  11. Viegas SF (2010) Ligamentous repair for acute scapholunate dissociation. In: Gelberman RH (ed) The wrist, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 211–222

    Google Scholar 

  12. Berger RA (1998) Radial-sided carpal instability. Instr Course Lect 47:219–228

    CAS  PubMed  Google Scholar 

  13. Ozcelik A, Gunal I, Kose N, Seber S, Omeroglu H (2005) Wrist ligaments: their significance in carpal instability. Ulus Travma Acil Cerrahi Derg 11:115–120

    PubMed  Google Scholar 

  14. Ozcelik A, Gunal I, Kose N (2005) Stress views in the radiography of scapholunate instability. Eur J Radiol 56:358–361

    Article  PubMed  Google Scholar 

  15. Watson HK, Ashmead D, Makhlouf MV (1988) Examination of the scaphoid. J Hand Surg [Am] 13:657–660

    Article  CAS  Google Scholar 

  16. Schmitt R, Lanz U (2011) Diagnostic imaging of the hand. Thieme, Stuttgart

    Google Scholar 

  17. Lee SK, Desai H, Silver B, Dhaliwal G, Paksima N (2011) Comparison of radiographic stress views for scapholunate dynamic instability in a cadaver model. J Hand Surg [Am] 36:1149–1157

    Article  Google Scholar 

  18. Schimmerl-Metz SM, Metz VM, Totterman SM, Mann FA, Gilula LA (1999) Radiologic measurement of the scapholunate joint: implications of biologic variation in scapholunate joint morphology. J Hand Surg 24:1237–1244

    Article  CAS  Google Scholar 

  19. Larsen CF, Stigsby B, Lindequist S, Bellstrom T, Mathiesen FK, Ipsen T (1991) Observer variability in measurements of carpal bone angles on lateral wrist radiographs. J Hand Surg [Am] 16:893–898

    Article  CAS  Google Scholar 

  20. Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL (1996) Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 78:357–365

    CAS  PubMed  Google Scholar 

  21. Kwon BC, Baek GH (2008) Fluoroscopic diagnosis of scapholunate interosseous ligament injuries in distal radius fractures. Clin Orthop Relat Res 466:969–976

    Article  PubMed Central  PubMed  Google Scholar 

  22. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Lijmer JG, Moher D, Rennie D, de Vet HC (2003) Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD Initiative. Radiology 226:24–28

    Article  PubMed  Google Scholar 

  23. Baratz ME, Dunn MJ (2004) Ligament injuries and instability of the carpus: scapholunate joint. In: Berger RA, Weiss APC (eds) Hand surgery. Lippincott Williams & Wilkins, Philadelphia, pp 481–494

    Google Scholar 

  24. Cautilli GP, Wehbe MA (1991) Scapho-lunate distance and cortical ring sign. J Hand Surg 16:501–503

    Article  CAS  Google Scholar 

  25. Geissler WB (2013) Management of scapholunate instability. In: Geissler WB (ed) Wrist arthroscopy. Springer, New York, pp 86–93

    Google Scholar 

  26. Kindynis P, Resnick D, Kang HS, Haller J, Sartoris DJ (1990) Demonstration of the scapholunate space with radiography. Radiology 175:278–280

    Article  CAS  PubMed  Google Scholar 

  27. Linscheid RL, Dobyns JH, Beabout JW, Bryan RS (1972) Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 54:1612–1632

    CAS  PubMed  Google Scholar 

  28. Vitello W, Gordon DA (2005) Obvious radiographic scapholunate dissociation: X-ray the other wrist. Am J Orthop (Belle Mead NJ) 34:347–351

    Google Scholar 

  29. Weinzweig J, Watson HK (2012) Dorsal wrist syndrome: predynamic carpal instability. In: Watson HK, Weinzweig J (eds) The wrist. Lippincott Williams & Wilkins, Philiadelphia, pp 483–490

    Google Scholar 

  30. Gharbaoui IS, Netscher DT, Kessler FB (2005) Chronic asymptomatic contralateral wrist scapholunate dissociation. Plast Reconstr Surg 116:1672–1678

    Article  CAS  PubMed  Google Scholar 

  31. Vance RM, Gelberman RH, Braun RM (1979) Chronic bilateral scapholunate dissociation without symptoms. J Hand Surg 4:178–180

    Article  CAS  Google Scholar 

  32. Picha BM, Konstantakos EK, Gordon DA (2012) Incidence of bilateral scapholunate dissociation in symptomatic and asymptomatic wrists. J Hand Surg [Am] 37:1130–1135

    Article  Google Scholar 

  33. Taleisnik J (1988) Current concepts review. Carpal instability. J Bone Joint Surg Am 70:1262–1268

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the German Osteoarthritis Aid ("Deutsche Arthrose-Hilfe e.V."), a non-profit foundation which supports clinical research on the diagnosis, prevention and treatment of osteoarthritis.

The scientific guarantor of this publication is Dirk Stengel, MD, PhD, MSc (Epi). The authors of this manuscript declare relationships with the following companies: Dr. Dornberger reports non-financial support from German Osteoarthritis Aid (Deutsche Arthrose-Hilfe e.V), during the conduct of the study.

Dr. Rademacher reports non-financial support from German Osteoarthritis Aid (Deutsche Arthrose Hilfe), during the conduct of the study. Prof. Mutze has nothing to disclose. Prof. Eisenschenk reports non-financial support from German Osteoarthritis Aid (Deutsche Arthrose Hilfe), during the conduct of the study. Dr. Stengel received honoraria, research grants and travel support by multiple sponsors and funding bodies (e.g. AO Trauma, Stryker, DePuy, Biomet, Aesculap). None related to this piece of research. This study received funding from the German Osteoarthritis Aid ("Deutsche Arthrose-Hilfe e.V."), a non-profit foundation which supports clinical research on the diagnosis, prevention and treatment of osteoarthritis. One of the authors has significant statistical expertise: Dirk Stengel, MD, PhD, MSc (Epidemiology), senior clinical epidemiologist and senior author of this manuscript. Institutional review board approval was obtained from the Charité University Medical Centre, Berlin, Germany (EA1/210/07). Written informed consent was obtained from all patients in this study. Study subjects or cohorts have not been previously reported. Methodology: prospective, diagnostic study, performed at one institution.

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Author notes

    Authors and Affiliations

    1. Department of Plastic Surgery and Burn Care, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Germany

      Jenny E. Dornberger

    2. Institute of Radiology, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Germany

      Grit Rademacher & Sven Mutze

    3. Department of Hand-, Replantation- and Microsurgery, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Germany

      Andreas Eisenschenk

    4. Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany

      Andreas Eisenschenk

    5. Centre for Clinical Research, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Germany

      Dirk Stengel

    6. Julius Wolff Institute, Centre for Musculoskeletal Surgery, Charité Medical University Centre, Berlin, Germany

      Dirk Stengel

    Authors
    1. Jenny E. Dornberger
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    2. Grit Rademacher
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    3. Sven Mutze
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    4. Andreas Eisenschenk
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    5. Dirk Stengel
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    Corresponding author

    Correspondence to Jenny E. Dornberger.

    Additional information

    Jenny E. Dornberger, Grit Rademacher, Andreas Eisenschenk and Dirk Stengel contributed equally to this work.

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    Dornberger, J.E., Rademacher, G., Mutze, S. et al. Accuracy of simple plain radiographic signs and measures to diagnose acute scapholunate ligament injuries of the wrist. Eur Radiol 25, 3488–3498 (2015). https://doi.org/10.1007/s00330-015-3776-2

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