Advertisement

Clinical Orthopaedics and Related Research

, Volume 466, Issue 4, pp 969–976 | Cite as

Fluoroscopic Diagnosis of Scapholunate Interosseous Ligament Injuries in Distal Radius Fractures

  • Bong Cheol KwonEmail author
  • Goo Hyun Baek
Original Article Fractures

Abstract

Early diagnosis of scapholunate interosseous ligament tears with distal radius fractures is likely important in treatment and outcome, but identification of these injuries has not been well explored. We asked whether there was a difference in the scapholunate interval between high-grade and low-grade tears of the scapholunate interosseous ligament in distal radius fractures, the best position of the wrists to identify any differences; we also asked what gap width accurately identified high-grade tears on fluoroscopic evaluation. We fluoroscopically evaluated the scapholunate gap in six different wrist positions and then performed arthroscopic examination in 45 distal radius fractures in 44 consecutive patients. The tears were classified as high-grade (Grade 3 or greater) or low-grade (Grade 2 or less) based on arthroscopic findings. We then compared the scapholunate gap measured on fluoroscopic images between the high-grade tear group and the low-grade tear group and between the different positions of the same wrist. The scapholunate gap was wider in the high-grade tear group than in the low-grade tear group and wider in ulnar deviation than in radial deviation. A 2-mm scapholunate gap appeared the best cutoff point for the fluoroscopic diagnosis. We concluded fluoroscopic examination is a good test for identifying high-grade tears of the scapholunate interosseous ligament in distal radius fractures.

Level of Evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Keywords

Distal Radius Fracture Kirschner Wire Ulnar Deviation Radial Deviation Wrist Position 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Dr. Hee Chan Ahn for assistance with measurement of fluoroscopic images and data arrangement.

References

  1. 1.
    Belsole RJ. Radiography of the wrist. Clin Orthop Relat Res. 1986;202:50–56.PubMedGoogle Scholar
  2. 2.
    Blatt G. Capsulodesis in reconstructive hand surgery: dorsal capsulodesis for the unstable scaphoid and volar capsulodesis following excision of the distal ulna. Hand Clin. 1987;3:81–102.PubMedGoogle Scholar
  3. 3.
    Braunstein EM, Louis DS, Greene TL, Hankin FM. Fluoroscopic and arthrographic evaluation of carpal instability. AJR Am J Roentgenol. 1985;144:1259–1262.PubMedGoogle Scholar
  4. 4.
    Cautilli GP, Wehbé MA. Scapho-lunate distance and cortical ring sign. J Hand Surg Am. 1991;16:501–503.PubMedGoogle Scholar
  5. 5.
    Cole RJ, Bindra RR, Evanoff BA, Gilula LA, Yamaguchi K, Gelberman RH. Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg Am. 1997;22:792–800.PubMedCrossRefGoogle Scholar
  6. 6.
    Forward DP, Lindau TR, Melsom DS. Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am. 2007;89:2334–2340.PubMedCrossRefGoogle Scholar
  7. 7.
    Frykman G. Fracture of the distal radius including sequelae: shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function: a clinical and experimental study. Acta Orthop Scand. 1967;Suppl 108:3+.Google Scholar
  8. 8.
    Garcia-Elias M, An KN, Amadio PC, Cooney WP, Linscheid RL. Reliability of carpal angle determinations. J Hand Surg Am. 1989;14:1017–1021.PubMedCrossRefGoogle Scholar
  9. 9.
    Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am. 1996;78:357–365.PubMedGoogle Scholar
  10. 10.
    Gilula LA, Hardy DC, Totty WG, Reinus WR. Fluoroscopic identification of torn intercarpal ligaments after injection of contrast material. AJR Am J Roentgenol. 1987;149:761–764.PubMedGoogle Scholar
  11. 11.
    Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453–458.PubMedGoogle Scholar
  12. 12.
    Kindynis P, Resnick D, Kang HS, Haller J, Sartoris DJ. Demonstration of the scapholunate space with radiography. Radiology. 1990;175:278–280.PubMedGoogle Scholar
  13. 13.
    Laulan J, Bismuth JP. Intracarpal ligamentous lesions associated with fractures of the distal radius: outcome at one year: a prospective study of 95 cases. Acta Orthop Belg. 1999;65:418–423.PubMedGoogle Scholar
  14. 14.
    Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist: diagnosis, classification, and pathomechanics. J Bone Joint Surg Am. 1972;54:1612–1632.PubMedGoogle Scholar
  15. 15.
    Meade TD, Schneider LH, Cherry K. Radiographic analysis of selective ligament sectioning at the carpal scaphoid: a cadaver study. J Hand Surg Am. 1990;15:855–862.PubMedCrossRefGoogle Scholar
  16. 16.
    Mehta JA, Bain GI, Heptinstall RJ. Anatomical reduction of intra-articular fractures of the distal radius: an arthroscopically-assisted approach. J Bone Joint Surg Br. 2000;82:79–86.PubMedCrossRefGoogle Scholar
  17. 17.
    Metz CE. Basic principles of ROC analysis. Semin Nucl Med. 1978;8:283–298.PubMedCrossRefGoogle Scholar
  18. 18.
    Metz VM, Wunderbaldinger P, Gilula LA. Update on imaging techniques of the wrist and hand. Clin Plast Surg. 1996;23:369–384.PubMedGoogle Scholar
  19. 19.
    Mitsuyasu H, Patterson RM, Shah MA, Buford WL, Iwamoto Y, Viegas SF. The role of the dorsal intercarpal ligament in dynamic and static scapholunate instability. J Hand Surg Am. 2004;29:279–288.PubMedCrossRefGoogle Scholar
  20. 20.
    Moneim MS. The tangential posteroanterior radiograph to demonstrate scapholunate dissociation. J Bone Joint Surg Am. 1981;63:1324–1326.PubMedGoogle Scholar
  21. 21.
    Nielsen PT, Hedeboe J. Posttraumatic scapholunate dissociation detected by wrist cineradiography. J Hand Surg Am. 1984;9:135–138.Google Scholar
  22. 22.
    O’Meeghan CJ, Stuart W, Mamo V, Stanley JK, Trail IA. The natural history of an untreated isolated scapholunate interosseus ligament injury. J Hand Surg Br. 2003;28:307–310.PubMedGoogle Scholar
  23. 23.
    Peicha G, Seibert F, Fellinger M, Grechenig W. Midterm results of arthroscopic treatment of scapholunate ligament lesions associated with intra-articular distal radius fractures. Knee Surg Sports Traumatol Arthrosc. 1999;7:327–333.PubMedCrossRefGoogle Scholar
  24. 24.
    Protas JM, Jackson WT. Evaluating carpal instabilities with fluoroscopy. AJR Am J Roentgenol. 1980;135:137–140.PubMedGoogle Scholar
  25. 25.
    Richards RS, Bennett JD, Roth JH, Milne K Jr. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am. 1997;22:772–776.PubMedCrossRefGoogle Scholar
  26. 26.
    Schimmerl-Metz SM, Metz VM, Totterman SM, Mann FA, Gilula LA. Radiologic measurement of the scapholunate joint: implications of biologic variation in scapholunate joint morphology. J Hand Surg Am. 1999;24:1237–1244.PubMedCrossRefGoogle Scholar
  27. 27.
    Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate. J Hand Surg Am. 2002;27:991–1002.PubMedCrossRefGoogle Scholar
  28. 28.
    Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: Part II. J Hand Surg Am. 2005;30:24–34.PubMedCrossRefGoogle Scholar
  29. 29.
    Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–428.CrossRefPubMedGoogle Scholar
  30. 30.
    Tang JB, Shi D, Gu YQ, Zhang QG. Can cast immobilization successfully treat scapholunate dissociation associated with distal radius fractures? J Hand Surg Am. 1996;21:583–590.PubMedCrossRefGoogle Scholar
  31. 31.
    Vitello W, Gordon DA. Obvious radiographic scapholunate dissociation: X-ray the other wrist. Am J Orthop. 2005;34:347–351.PubMedGoogle Scholar
  32. 32.
    Watson H, Ottoni L, Pitts EC, Handal AG. Rotary subluxation of the scaphoid: a spectrum of instability. J Hand Surg Br. 1993;18:62–64.PubMedCrossRefGoogle Scholar
  33. 33.
    Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am. 1984;9:358–365.PubMedGoogle Scholar
  34. 34.
    Watson HK, Weinzweig J, Zeppieri J. The natural progression of scaphoid instability. Hand Clin. 1997;13:39–49.PubMedGoogle Scholar
  35. 35.
    Weiss AP, Sachar K, Glowacki KA. Arthroscopic debridement alone for intercarpal ligament tears. J Hand Surg Am. 1997;22:344–349.PubMedCrossRefGoogle Scholar
  36. 36.
    Whipple TL. The role of arthroscopy in the treatment of scapholunate instability. Hand Clin. 1995;11:37–40.PubMedGoogle Scholar
  37. 37.
    Wiesler ER, Poehling GG. Arthroscopy of the wrist: operation room setup and technique. In: McGinty J, Burkhart SS, Jackson RW, Johnson DH, Richmond JC, eds. Operative Arthroscopy. 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2003:729–736.Google Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryHallym University Sacred Heart HospitalKyeonggidoKorea
  2. 2.Department of Orthopedic SurgerySeoul National University College of MedicineSeoulKorea

Personalised recommendations