Midterm results of arthroscopic treatment of scapholunate ligament lesions associated with intra-articular distal radius fractures

Abstract

Since 1993, we have treated 30 patients with acute intra-articular distal radius fractures using arthroscopic assistance. Concomitant lesions of the intrinsic scapholunate (SL) ligaments were diagnosed in 12 patients (40%). Using the grading system of Geissler et al. [13], the identified lesions included a single grade I tear, three grade II, six grade III, and two grade IV. The grade III and IV lesions were accompanied by intraoperative findings of marked instability. Therefore operative stabilization was performed by temporary scapholunate and scaphocapitate arthrodesis. Seven patients in this group (87.5%) were followed up clinically and radiologically for an average of 3 years postoperatively. Clinical examination included range of motion and a subjective questionnaire concerning pain and ability to work. Objective grip strength was measured using a Jamar-tester and compared to the contralateral wrist. Radiological evaluation consisted of posteroanterior and lateral views and of stress views in radial and ulnar deviation. Data were evaluated by the scoring systems of Jakim et al. [21], Cooney et al. [5] and by the demerit point system of Gartland and Werley [12], as modified by Sarmiento et al. [36]. An excellent result was present in 100% of our patients by the Gartland and Werley system, in 86% by that of Jakim et al., and in 60% by that of Cooney et al. Based on a subjective questionnaire, all of the patients had an excellent or good result.

Analysis of the Arthroscopically Diagnosed Soft-Tissue Injuries Associated With the Distal Radius Fractures

“…The ligamentous injuries may lead to carpal instability, it may be easier to treat them at the time of the initial presentation, and doing so has been shown to lead to improved outcomes [1,30,31]. However, the natural history and clinical importance of these ligament injuries associated with distal radius fractures are not yet known and understood.…”

Fluoroscopic Diagnosis of Scapholunate Interosseous Ligament Injuries in Distal Radius Fractures

“…High-grade SLIL tear associated with distal radius fractures is not rare [9,16,23,25] and is likely to result in progressive deterioration of wrist function with increasing wrist pain [6,13,30]. Arthroscopy, which is the gold standard for the diagnosis, may not be readily available depending on the condition of the institution, the surgeon, or the insurance, whereas fluoroscopy is widely available, easy to use, and inexpensive.…”

“…Injury to the scapholunate interosseous ligament (SLIL) has been reported to occur in 16% to 40% of patients with distal radius fractures [9,23,25], injury to the lunotriquetral ligament injury in 8.5% to 15% of patients [9,25], and injury to the triangular fibrocartilage complex in 39% to 43% [9,25].…”

Arthroscopic Management of Scapholunate Dissociation

“…In fact, the prevalence of SL ligamentous injury in displaced distal radius fractures have been found to be as high as 85%, but also as low as 18% ( Fig. 8.2) [9,12,16,18]. The impact of intra-articular fracture distribution is further emphasized by the fact that late presenting symptomatic SL dissociations have been found in patients with arthroscopically-diagnosed grade 3 and 4 SL ligament tears at the time of the fracture (Table 8.1) [3].…”

“…8.2) [9]. Of all these, SL tears grade 3 or 4, if left untreated, lead to SL dissociation and possibly later carpal instability [3,16].…”