Emergency Radiology

, Volume 2, Issue 2, pp 77–83 | Cite as

Signs of acute carpal instability associated with distal radial fracture

  • Jody S. Lee
  • Amar Galla
  • Robert L. Shaw
  • John H. HarrisJr.
Original Article


The posteroanterior and lateral wrist radiographs of 52 adults who sustained acute distal radial fractures were reviewed to determine the incidence of radiographic signs of concomitant acute scapholunate ligamentous injury. Three radiographic criteria, either separately or in concert, were used to identify scapholunate ligamentous injury. They are (a) scapholunate angle >60°; (b) widening of the scapholunate space >2 mm; and (c) the cortical ring sign (also called the scaphoid or signet ring sign). Thirty-six of 52 cases (69%; 95% confidence interval =52.1–82.2%) showed evidence of scapholunate ligamentous injury; 16 of 52 cases (31%; 95% confidence interval =16.8–46.6%) showed no evidence of scapholunate ligamentous injury. Statistical analysis suggests that a minimum of 52.1% of all adult distal radial fractures are associated with signs of concurrent acute scapholunate ligamentous injury. The analysis also suggests that independent variables such as age, gender, severity of radius fracture, or mechanism of injury do not significantly alter the incidence of associated carpal ligamentous instability.

This study has established a greater than 52.1% incidence of radiographic signs of scapholunate instability in adults with acute distal radial fractures. It is incumbent upon radiologists to search for the signs of scapholunate dissociation in all adult cases of distal radius fracture, regardless of age, gender, severity of radius fracture, or mechanism of injury.

Key Words

Distal radius fracture Carpal instability Scapholunate dissociation Scaphoid subluxation Scapholunate angle 


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Copyright information

© the American Society of Emergency Radiology 1995

Authors and Affiliations

  • Jody S. Lee
    • 3
  • Amar Galla
    • 1
  • Robert L. Shaw
    • 2
  • John H. HarrisJr.
    • 3
  1. 1.Department of RadiologyNassau County Medical CenterEast Meadow
  2. 2.Department of Diagnostic ImagingNorthwick Park HospitalMiddlesexUnited Kingdom
  3. 3.Department of Diagnostic RadiologyUniversity of Texas Health Science Center—HoustonHouston

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