Fluoroscopic Diagnosis of Scapholunate Interosseous Ligament Injuries in Distal Radius 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 lowgrade tear group and between the different positions of the same wrist. The scapholunate gap was wider in the highgrade 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.

Wrist Instability

“…A study by Pliefke et al (2008) mentioned a sensitivity of 86 % with a specificity of 95 %. A study by Kwon and Baek 2008, using a cutoff point of a 2 mm scapho-lunate gap at fluoroscopy, mentioned a maximum sensitivity of 95 % (Kwon and Baek 2008). In an unpublished study by the authors a sensitivity of 95 % was found.…”

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

“…Instability was classified according to Geissler [20]. As suggested by other authors, grade III and IV injuries were classified as pathologic findings requiring open ligament repair and Kirschner wire fixation [5,21]. In case of grade II tears, the stability of the joint was tested intraoperatively and repaired if necessary.…”

Intra-Articular Fracture of the Distal Radius: Arthroscopic-Assisted Reduction

“…30 Some contend that arthroscopy is the reference standard for diagnosis of ligament tears associated with distal radius fractures. 31 Triangular fibrocartilage complex injuries are detected and treated during the radiocarpal part of the arthroscopy.…”