Archives of Orthopaedic and Trauma Surgery

, Volume 135, Issue 6, pp 831–838 | Cite as

Influence of associated lesions of the intrinsic ligaments on distal radius fractures outcome

  • Katerina KasapinovaEmail author
  • Viktor Kamiloski
Arthroscopy and Sports Medicine



We aimed to evaluate the influence of associated scapholunate (SL) and/or lunotriquetral ligament (LT) injury on the outcome of distal radius fractures.

Materials and methods

This prospective study included 40 patients with surgically treated distal radius fracture. Wrist arthroscopy was used to identify associated lesions of the scapholunate and lunotriquetral ligaments and classify them according to Geissler. Patients were divided in two groups by presence (injured group) or absence (intact group) of associated injury of the SL and/or LT ligament. The patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaires were used to evaluate disability 3 and 6 months after injury. Grip strength was also evaluated.


Wrist arthroscopy identified SL and/or LT injury in 15 patients (37.5 %). Mean total PRWE score for the intact group was 26.64 at 3 months and 16.22 at 6 months, and 50.47 (at 3 months) and 20.7 (at 6 months) for the group with ligament injury. Mean DASH scores were 26.03 and 13 at 3 and 6 months for the intact group, and 49.5 and 24.11 for the injured group. Mann–Whitney test results showed significant difference for the PRWE and DASH scores and the grip strength for the two examined groups.


Patients with distal radius fracture with associated intrinsic ligament injury had worse outcomes than did patients without associated ligamentous injury. Associated injuries of the SL and LT ligament should be considered when treating distal radius fractures, and wrist arthroscopy should be incorporated into the operative protocol.


Distal radius fracture Scapholunate ligament Lunotriquetral ligament Wrist arthroscopy Disability 



The authors did not receive financial support for this study.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Anzarut A, Johnson JA, Rowe BH et al (2004) Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg Am 29:1121–1127. doi: 10.1016/j.jhsa.2004.07.002 CrossRefPubMedGoogle Scholar
  2. 2.
    Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C (2001) Measuring the whole or the parts? Validity, reliability and responsiveness of the Disabilities of the Arm, Shoulder and Hand Outcome Measure in different regions of the upper extremity. J Hand Ther 4:128–146. doi: 10.1016/S0894-1130(01)80043-0 CrossRefGoogle Scholar
  3. 3.
    DelPinal F, Mathoulin C, Luchetti R (2010) Arthroscopic management of distal radius fractures. Springer Verlag, BerlinGoogle Scholar
  4. 4.
    Dias JJ, Rajan RA, Thompson JR (2008) Which questionnaire is best? The reliability, validity and ease of use of the Patient Evaluation Measure, The Disabilities of the Arm, Shoulder and Hand and the Michigan Hand Outcome Measure. J Hand Surg Eur 33:9–17. doi: 10.1177/1753193407087121 CrossRefGoogle Scholar
  5. 5.
    Fernandez DL (2000) Should anatomic reduction be pursued in distal radial fractures? J Hand Surg Eur 25:523–527. doi: 10.1054/jhsb.2000.0516 CrossRefGoogle Scholar
  6. 6.
    Fontès D (1995) Therapeutic interest of wrist arthroscopy (a series of 280 cases). In: 6th Congress of IFSSH. Monduzzi, Bologna, pp 723–728Google Scholar
  7. 7.
    Forward DP, Davis TR, Sithole JS (2008) Do young patients with malunited fractures of the distal radius inevitably develop symptomatic posttraumatic osteoarthritis? J Bone Joint Surg Br 90:629–637. doi: 10.1302/0301-620X.90B5.19448 CrossRefPubMedGoogle Scholar
  8. 8.
    Forward DP, Lindau TR, Melson DS (2007) Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am 89:2334–2340. doi: 10.2106/JBJS.F.01537 CrossRefPubMedGoogle Scholar
  9. 9.
    Garratt A, Schmidt L, Mackintosh A, Fitzpatrick R (2002) Quality of life measurement: bibliographic study of patient assessed health outcome measures. BMJ 324:1417. doi: 10.1136/bmj.324.7351.1417 CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Geissler WB (2005) Intra-articular distal radius fractures: the role of arthroscopy? Hand Clin 21:407–416. doi: 10.1016/j.hcl.2005.02.009 CrossRefPubMedGoogle Scholar
  11. 11.
    Geissler WB (2005) Wrist arthroscopy. Springer Science Business Media, New York. ISBN 978-0-387-27087-6CrossRefGoogle Scholar
  12. 12.
    Geissler WB, Freeland AE, Savoi FH et al (1996) Intracarpal soft tissue lesions associated with an intraarticular fracture of the distal end of the radius. J Bone Joint Surg Am 78:357–365PubMedGoogle Scholar
  13. 13.
    Goldfarb CA, Rudzki JR, Catalano LW, Hughes M, Borrelli JJ (2006) Fifteen-year outcome of displaced intra-articular fractures of the distal radius. J Hand Surg Am 31:633–639. doi: 10.1016/j.jhsa.2006.01.008 CrossRefPubMedGoogle Scholar
  14. 14.
    Hanker GJ (2001) Radius fractures in the athlete. Clin Sports Med 20:189–201. doi: 10.1016/S0278-5919(05)70255-6 CrossRefPubMedGoogle Scholar
  15. 15.
    Karnezis IA, Fragkiadakis EG (2002) Association between objective clinical variables and patient-rated disability of the wrist. J Bone Joint Surg Br 84:967–970. doi: 10.1302/0301-620X.84B7.12673 CrossRefPubMedGoogle Scholar
  16. 16.
    Karnezis IA, Panagiotopoulos E, Tyllianakis M, Megas P, Lambiris E (2005) Correlation between radiological parameters and patient-rated wrist dysfunction following fractures of the distal radius. Injury 36:1435–1439. doi: 10.1016/j.injury.2005.09.005 CrossRefPubMedGoogle Scholar
  17. 17.
    Kitay A, Wolfe SW (2012) Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 37:2175–2196. doi: 10.1016/j.jhsa.2012.07.035 CrossRefPubMedGoogle Scholar
  18. 18.
    Knirk JL, Jupiter JB (1986) Intraarticular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 68:647–659PubMedGoogle Scholar
  19. 19.
    Lindau T, Arner M, Hagberg L (1997) Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg Eur 22:638–643CrossRefGoogle Scholar
  20. 20.
    Lozano-Calderon SA, Souer S, Mudgal C, Jupiter JB, Ring D (2008) Wrist mobilization following volar plate fixation of fractures of the distal part of the radius. J Bone Joint Surg Am 90:1297–1304. doi: 10.2106/JBJS.G.01368 CrossRefPubMedGoogle Scholar
  21. 21.
    MacDermid JC, Richards RS, Donner A, Bellamy N, Roth JH (2000) Responsiveness of the short form-36, disability of the arm, shoulder and hand questionnaire, Patient-Rated Wrist Evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture. J Hand Surg Am 25:330–340. doi: 10.1053/jhsu.2000.jhsu25a0330 CrossRefPubMedGoogle Scholar
  22. 22.
    MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH (1998) Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 12:577–586. doi: 10.1097/00005131-199811000-00009 CrossRefPubMedGoogle Scholar
  23. 23.
    Mathiowetz V, Weber K, Volland G, Kashman N (1984) Reliability and validity of grip and pinch strength evaluations. J Hand Surg 9:222–226. doi: 10.1016/S0363-5023(84)80146-X CrossRefGoogle Scholar
  24. 24.
    Mehta JA, Bain GI, Heptinstall RJ (2000) Anatomical reduction of intra-articular fractures of the distal radius (an arthroscopically-assisted approach). J Bone Joint Surg Br 82:79–86CrossRefPubMedGoogle Scholar
  25. 25.
    Peicha G, Seibert F, Fellinger M et al (1999) Midterm results of arthroscopic treatment of scapholunate ligament lesions associated with intra-articular distal radius fractures. Knee Surg Sports Traumatol Arthrosc 7:327–333. doi: 10.1007/s001670050172 CrossRefPubMedGoogle Scholar
  26. 26.
    Richards RS, Bennett JD, Roth JH, Milne K (1997) Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am 22:772–776. doi: 10.1016/S0363-5023(97)80068-8 CrossRefPubMedGoogle Scholar
  27. 27.
    Ruch DS, Poehling GG (1996) Arthroscopic management of partial scapholunate and lunotriquetral injuries of the wrist. J Hand Surg Am 21:412–417. doi: 10.1016/S0363-5023(96)80354-6 CrossRefPubMedGoogle Scholar
  28. 28.
    Shin AY, Deitch MA, Sachar K, Boyer MI (2004) Ulnar-sided wrist pain. J Bone Joint Surg Am 86:1560–1574Google Scholar
  29. 29.
    Smith DW, Henry MH (2002) Comprehensive management of soft-tissue injuries associated with distal radius fractures. J Am Soc Surg Hand 2:153–164. doi: 10.1053/jssh.2002.34797 CrossRefGoogle Scholar
  30. 30.
    Walenkamp MMJ, Bentohami A, Beerekamp MSH, Peters RW, van der Heiden R, Goslings JC, Schep NWL (2013) Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis. Strat Traum Limb Recon 8:67–75. doi: 10.1007/s11751-013-0169-4 CrossRefGoogle Scholar
  31. 31.
    Weiss AP, Sachar K, Glowacki KA (1997) Arthroscopic debridement alone for intercarpal ligament tears. J Hand Surg Am 22:344–349. doi: 10.1016/S0363-5023(97)80176-1 CrossRefPubMedGoogle Scholar
  32. 32.
    Westkaemper JG, Mitsionis G, Giannakopoulos PN, Sotereanos DG (1998) Wrist arthroscopy for the treatment of ligament and triangular fibrocartilage complex injuries. Arthroscopy 14:479–483. doi: 10.1016/S0749-8063(98)70075-1 CrossRefPubMedGoogle Scholar
  33. 33.
    Young CF, Nanu AM, Checketts RG (2003) Seven-year outcome following Colles’ type distal radial fracture. Comparison of two treatment methods. J Hand Surg Eur 28:422–426. doi: 10.1016/S0266-7681(02)00394-7 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Medical FacultyUniversity “St. Cyril and Metodius”SkopjeRepublic of Macedonia
  2. 2.Department of TraumatologyUniversity Surgery Clinic “St. Naum Ohridski” SkopjeSkopjeRepublic of Macedonia

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