The functional outcome of acute scapholunate ligament repair in patients with intraarticular distal radius fractures treated by internal fixation

Gradl, Gertraud; Pillukat, Thomas; Fuchsberger, Thomas; Knobe, Matthias; Ring, David; Prommersberger, K.-J.

doi:10.1007/s00402-013-1797-3

Cited by 18 publications

(11 citation statements)

References 28 publications

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“…In our study, we found a statistically significant difference in postoperative strength but only a slight difference regarding postoperative mobility in patients with distal radius fractures in combination with isolated SL ligament rupture. This corresponds to the results of Gradl et al In their retrospective study, they describe comparable functional results between patients with isolated distal radius fractures and distal radius fractures in combination with SL ligament injuries, if addressed intraoperatively [16]. Moreover, the consequences of a missed SL ligament tear with following SL dissociation and wrist arthrosis are fatal.…”

Section: Discussionsupporting

confidence: 86%

“…For example, Lindau et al describe a follow-up of 43 patients [15] one year after arthroscopically assisted fracture treatment of a distal radius fracture in combination with a TFCC lesion. Gradl et al included 18 patients with lesions of the SL ligament in a retrospective follow-up [16]. One of the few recent studies with a slightly larger number of patients is the prospective study by Kaspinova et al [17], who enrolled 85 patients after arthroscopically assisted treated distal radius fracture.…”

Section: Discussionmentioning

confidence: 99%

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The Outcome of Distal Radius Fractures with Concomitant Injuries Is Similar to those of Isolated Distal Radius Fractures Provided that an Arthroscopically Supported Treatment Is Performed

Matthey

Schmid

Zyskowski

et al. 2020

JCM

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Background: Concomitant injuries of distal radius fractures (DRF) can have a fatal impact on the patients’ outcome. However, wrist arthroscopy is a costly and complex procedure. It remains elusive whether patients benefit from an additional arthroscopy. Methods: Patients with a DRF who were treated arthroscopically were enrolled. Fifty-six wrists were evaluated regarding their function by self-assessment with the Munich Wrist Questionnaire (MWQ). Thirty-nine patients were examined for postoperative strength and motion. Concomitant injuries were detected. Results: A total of 75% of the DRF were type C injuries (AO classification). Twenty-four cases (43%) were triangular fibrocartilaginous complex (TFCC) lesion, eight cases (14%) of scapholunate ligament (SL) injuries and seven cases (12%) were a combination of TFCC and SL ligament lesion. No difference in function could be detected between DRF with surgically addressed concomitant lesions and isolated DRF. Dorsalextension, palmarflexion and grip strength were significantly reduced in patients with DRF and concomitant injuries compared to the healthy wrist. However, patients with DRF and arthroscopically treated concomitant injuries had similar results to those suffering only from an isolated DRF. Conclusion: The increased occurrence of concomitant injuries is to be expected in intraarticular DRF. Patients with concomitant injuries benefit from an arthroscopically assisted fracture treatment and show similar results compared to isolated DRF.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

The Outcome of Distal Radius Fractures with Concomitant Injuries Is Similar to those of Isolated Distal Radius Fractures Provided that an Arthroscopically Supported Treatment Is Performed

Matthey

Schmid

Zyskowski

et al. 2020

JCM

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“…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.…”

Section: Discussionmentioning

confidence: 86%

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

et al. 2018

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Radiographic diagnosis of scapholunate ligament injury (SLI) in the setting of distal radius fractures (DRFs) is challenging. It remains unclear to what extent radiographic diagnosis of SLI by a radiologist influences surgical decision-making regarding treatment of SLI. We aimed to (1) identify the number of times that concerns for the possibility of concurrent SLI in the setting of a DRF had been raised by the radiologists, (2) identify how often the radiologist's diagnosis was confirmed by the treating surgeon, and (3) how many of the patients with a radiographic concern for SLI by the radiologist received operative treatment for the SLI. Based on Current Procedural Terminology codes, we identified 2,923 patients that were operatively treated for their DRF in 1 of 3 participating institutions in an urban city in the United States. We reviewed the medical charts of 654 patients who had a mention of scapholunate ligament (SL) distance in their radiography, surgery, or clinical notes. We then measured the SL distance and recorded patient, diagnosis, and treatment characteristics of all these patients. A total of 200 out of 2,923 patients (6.8%) received a radiological diagnosis of SLI. In seven of these patients (3.5%), the surgeon confirmed the diagnosis of the radiologist. Four patients (2%) had operative repair of their SLI. Radiologists demonstrate a low threshold to identify SLI in the setting of DRFs, while the number of SLIs identified by the treating surgeon is a remarkably smaller number. Level II, prognostic study.

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“…However, that study had several limitations: 39 of 57 eligible patients did not participate, ligament treatment was heterogeneous (nine had direct repair, nine had pinning only), there were no untreated confirmed ligament tears for comparison, follow-up was relatively brief (minimum 12 months), and QuickDASH scores were suboptimal in both groups (27 with ligament procedure, 22 without) compared to prior studies of volar plating (average scores 4 or 5) [20,23]. Thus, the authors assert, Bwe cannot state definitively that recognizing and treating scapholunate instability improves motion, grip, and comfort, or limits the potential for future arthrosis.^ [10] However, they concluded that such treatment is Bworthwhile in active patients,^which is compatible with the consensus supporting ligament surgery, as mentioned earlier.…”

Section: Ligament Repairmentioning

confidence: 95%

Scapholunate Instability after Distal Radius Volar Plating

Jones

Everding

Desmarais

et al. 2015

Hand (New York, N,Y.)

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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.

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The functional outcome of acute scapholunate ligament repair in patients with intraarticular distal radius fractures treated by internal fixation

Abstract: The outcomes of intraarticular fractures of the distal radius with operatively treated associated SLI are comparable with the outcomes of intraarticular fractures of the distal radius without associated SLI.

Cited by 18 publications

References 28 publications

The Outcome of Distal Radius Fractures with Concomitant Injuries Is Similar to those of Isolated Distal Radius Fractures Provided that an Arthroscopically Supported Treatment Is Performed

The Outcome of Distal Radius Fractures with Concomitant Injuries Is Similar to those of Isolated Distal Radius Fractures Provided that an Arthroscopically Supported Treatment Is Performed

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

Scapholunate Instability after Distal Radius Volar Plating

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