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European Radiology

, Volume 26, Issue 3, pp 722–732 | Cite as

Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography

  • A. Klempka
  • M. Wagner
  • S. Fodor
  • K. J. Prommersberger
  • M. Uder
  • R. Schmitt
Musculoskeletal

Abstract

Objectives

To evaluate the prevalence of injuries of the scapholunate and lunotriquetral interosseous ligaments (SLIL, LTIL) as well as the triangular fibrocartilage complex (TFCC) in intra-articular distal radius fractures (iaDRF).

Methods

Two hundred and thirty-three patients with acute iaDRF underwent MDCT arthrography. The SLIL and LTIL were described as normal, partially or completely ruptured. Major injuries of the SLIL were defined as completely ruptured dorsal segments, those of the LTIL as completely ruptured palmar segments. The TFCC was judged as normal or injured. Interobserver variability was calculated. Injury findings were correlated with the types of iaDRF (AO classification).

Results

In 159 patients (68.2 %), no SLIL injuries were seen. Minor SLIL injuries were detected in 54 patients (23.2 %), major injuries in 20 patients (8.6 %). No correlation was found between the presence of SLIL lesions and the types of iaDRF. Minor LTIL injuries were seen in 23 patients (9.9 %), major injuries in only 5 patients (2.2 %). The TFCC was altered in 141 patients (60.5 %). Interobserver variability was high for MDCT arthrography in assessing SLIL and TFC lesions, and fair for LTIL lesions.

Conclusion

In iaDRF, prevalence of major injuries of the most relevant SLIL is about 9 % as evaluated with CT arthrography.

Key Points

The C-shaped SLIL is built of dorsal, middle and palmar segments.

In iaDRF, major SLIL injuries are associated in 8.6 % of the cases.

In iaDRF, the SLIL remains intact in 68.3 % of the cases.

IaDRF and SLIL ruptures can comprehensively be depicted with MDCT arthrography.

A three-compartment approach is recommended to assess intrinsic ligaments and the TFCC.

Keywords

Arthrography Multidetector Computed Tomography Radius Fractures Ligaments Wrist Injuries 

Abbreviations

iaDRF

intra-articular Distal Radius Fracture

LTIL

LunoTriquetral Interosseous Ligament

dSLIL

dorsal segment of the ScaphoLunate Interosseous Ligament

mSLIL

middle segment of the ScaphoLunate Interosseous Ligament

pSLIL

palmar segment of the ScaphoLunate Interosseous Ligament

MDCT

MultiDetector Computed Tomography

MPR

MultiPlanar Reformation

OR

Odds Ratio

p

p-value

SLD

ScaphoLunate Dissociation

SLIL

ScaphoLunate Interosseous Ligament

TFC

Triangular FibroCartilage (ulnocarpal disc)

TFCC

Triangular FibroCartilage Complex

Notes

Acknowledgements

The present work was performed in fulfillment of the requirements for obtaining the degree “Dr. med.” of the Friedrich-Alexander-University Erlangen-Nürnberg (FAU).

The scientific guarantor of this publication is Prof. Rainer Schmitt (Department of Diagnostic and Interventional Radiology, Cardiovascular Center, Salzburger Leite 1, 97616 Bad Neustadt an der Saale, Germany). The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Daniela Keller (Germany) kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • A. Klempka
    • 1
  • M. Wagner
    • 1
  • S. Fodor
    • 1
  • K. J. Prommersberger
    • 2
  • M. Uder
    • 3
  • R. Schmitt
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyCardiovascular Center Bad Neustadt an der SaaleBad Neustadt an der SaaleGermany
  2. 2.Clinic for Hand SurgeryBad Neustadt an der SaaleGermany
  3. 3.Department of Diagnostic RadiologyFriedrich-Alexander-University Erlangen-Nürnberg (FAU)ErlangenGermany

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