Lesions of the scapholunate ligaments in acute wrist trauma - arthroscopic diagnosis and minimally invasive treatment

Abstract

The final result of the treatment of distal intra-articular radius fractures depends both on the accuracy of the fracture reduction and on the presence of additional carpal injuries. In particular, lesions of the intrinsic ligaments usually lead to severe degenerative damage of the wrist joint if they are missed primarily. With the introduction of wrist arthroscopy, these tears can be evaluated and treated earlier. Since 1993 arthroscopically assisted treatment has been performed in 23 patients with distal intra-articular fractures of the radius (mainly C-fractures according to the AO classification system or group VII and VIII fractures according to Frykman). Scapholunate (SL) tears were found in 11 patients (47.8%), 7 of whom showed marked instability intraoperatively and were stabilised at the time of surgery.

Fractures of the distal radius treated by internal fixation and early function

“…Recent reports have described associated tears of the triangular radioulnar ligament in up to 53% and of the scapholunate ligament in up to 21% of extra-and intraarticular fractures of the distal radius. [33][34][35] It has been suggested that these injuries were responsible for poor results unless they were diagnosed and treated early, but their clinical significance is not entirely clear. We believe that minor tears of the intercarpal ligaments do not lead to significant instability and heal without further treatment, provided that the anatomy of the joint, including the distal radioulnar joint, is meticulously restored and undue traction with external fixation devices is avoided.…”

Open Treatment of Acute Scapholunate Instability

“…[50][51][52][53][54][55][56] Rates when diagnosed radiographically range from 13.3% to 29%. [57][58][59][60][61][62] Mudgal and Hastings suggest the mechanism of this combined injury can be attributed to a combination of tensile stress in ulnar deviation and axial (compression) stress in either radial or ulnar deviation.…”

Anatomical and safety considerations in establishing portals used for wrist arthroscopy

“…It is especially effective in young patients suffering from distal intraarticular radius fractures when the reduction and fracture treatment can be performed under arthroscopic assistance. At the same time, lesions of the TFCC (triangular fibrocartilage complex) and of the intrinsic ligaments can be evaluated and treated under arthroscopic view as known from Adolfson (1994), Cooney et al (1990), Dautel et al (1993), Fellinger et al (1995), Knopp et al (1988), and Peicha et al (1997).…”