Scapholunate Instability after Distal Radius Volar Plating

Abstract

Background Prior to volar locked plating and early motion protocols, ligamentous injuries incidentally associated with distal radius fractures may have been indirectly treated with immobilization. Our goal was to determine the prevalence of scapholunate instability in our population, while identifying those who may have had progression of instability. Methods We retrospectively reviewed 221 distal radius fractures treated with a volar locking plate during a 6-year period. Average patient age was 59 years. Standard posteroanterior and lateral radiographs from the first and last postoperative visits were analyzed for scapholunate instability, using the criteria of scapholunate gap ≥3 mm and scapholunate angle ≥60°. Results Six patients (3 %) met neither or only one criterion for instability at the first postoperative visit and did not have ligament repair and then went on to meet both criteria at the last postoperative visit after an early motion protocol. Seven patients (3 %) met both criteria at the first and last postoperative visits and did not have ligament repair. Five patients (2 %) underwent primary scapholunate ligament repair at the time of distal radius fixation. Conclusions In our representative population, scapholunate instability was uncommon, either from initial injury or possible progression of occult ligament injury, despite early motion without operative treatment of the ligament. Thus, we did not find strong evidence for routinely delaying motion or pursuing further workup. When early radiographs clearly demonstrate acute scapholunate instability, more aggressive treatment may be appropriate for selected patients.

Incidence and Functional Outcomes of Scapholunate Diastases Associated Distal Radius Fractures: A 2-year Follow-Up Scapholunate Dissociation

“…In the acute posttraumatic radiographs of distal radius fractures, a scapholunate diastasis (>3mm) is often seen [ 8 , 16 , 17 ]. However, these are not always clinically relevant.…”

Radiographic Diagnosis of Scapholunate Diastasis in Distal Radius Fractures: Implications for Surgical Practice

“…More recent studies indicate that surgical repair of SLI is especially worthwhile in patients with (radiographic) signs of severe SLI and/or a high functional demand of their injured wrist. 2,29 Overall, our findings indicate that the current abilities to radiographically diagnose SLI effectively in the setting of a DRF are suboptimal. Based on our data, it appears that radiographic diagnosis of SLI is challenging and often does not seem to correspond with clinical concerns by the treating surgeons.…”

“…Numerous studies have reported varying incidences of SLI associated with DRFs, based on either medical imaging or arthroscopy of the wrist. [1][2][3][4][5][14][15][16] The incidence of specifically radiographically diagnosed SLI in patients who were operatively treated for DRFs seems to lie between 8.1 and 32%. 2,15 Although radiographs are considered to be a reliable tool in diagnosing SLI, 17,18 plain radiographs seem to be more useful for excluding rather than confirming SLI.…”

“…[1][2][3][4][5][14][15][16] The incidence of specifically radiographically diagnosed SLI in patients who were operatively treated for DRFs seems to lie between 8.1 and 32%. 2,15 Although radiographs are considered to be a reliable tool in diagnosing SLI, 17,18 plain radiographs seem to be more useful for excluding rather than confirming SLI. 9 In this study, 200 out of the 2,923 patients (6.8%) who were operatively treated for their DRF had signs of SLI on their plain radiographs taken in the course treatment of the DRF (►Table 2), as diagnosed by a radiologist.…”

Fracturas intraarticulares de radio distal: reducción bajo fluoroscopía versus asistencia artroscópica. Revisión sistemática

“…A pesar de esto, no existen investigaciones que a largo plazo nos permitan identificar cuáles son sintomáticas y deben ser tratadas en este contexto. 30 Es frecuente observar en radiografías de fracturas de radio distal distasis del espacio escafosemilunar mayor de 3 mm; 31,32,33 sin embargo, no siempre es clínicamente relevante, tal vez debido a la cicatrización ligamentaria durante la inmovilización. 34,35,36,37 La artroscopía se ha convertido en una herramienta de uso frecuente para diagnóstico y tratamiento de patología de muñeca entre los cirujanos de miembro superior, es importante destacar que la curva de aprendizaje es exigente.…”