The significance of conventional radiographic parameters in the diagnosis of scapholunate ligament lesions

Abstract

We were able to validate plain radiographs as a reliable tool in the work-up of patients with suspected SL ligament injuries. However, wrist arthroscopy remains the gold standard in diagnosing and treating these lesions.

Radiographic Diagnosis of Scapholunate Dissociation Among Intra-articular Fractures of the Distal Radius: Interobserver Reliability

“…Radiographic signs of SLD include widening of the scapholunate gap, a scapholunate angle greater than 70°, discontinuity in the Gilula lines, and the presence of a scaphoid ring sign. [13][14][15] The scaphoid ring sign is visible on posteroanterior radiographs when the distal pole of the scaphoid is superimposed on the waist of the flexed, foreshortened scaphoid. 3 All of these signs are indicative but not diagnostic of SLD, and differences in positioning of the wrist and radiographic and measurement techniques account for a high degree of variability.…”

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

“…Variations are partially due to different measuring techniques [3,18,24], but the mid portion of the SL joint should be used as the preferred anatomical landmark [5,17,25,26]. In this study, SL distances of 3.0 and 3.7 mm on pa and Stecher's projection were associated with the optimal balance between sensitivity and specificity, targeting SL lesions of grade III and higher according to the widely accepted Geissler staging system.…”

“…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.…”

“…Plain radiographs remain a ubiquitously available and cost-effective clinical standard for the initial diagnostic work-up of wrist injuries, and an abundance of measures and indirect signs have been proposed which may signal deterioration of carpal alignment caused by ligament ruptures. The best known indices are a widened SL joint space and abnormalities of the carpal angles [3][4][5]. Other radiologic features like disruption of carpal arc alignment, a foreshortened scaphoid, loss of SL articular parallelism or asymmetric widening and a dorsally or subdisplaced scaphoid onto the dorsal rim of the radius in lateral projection have also been associated with this condition and may indicate ligament disruption [6][7][8][9].…”

Management of Intercarpal Ligament Injuries Associated with Distal Radius Fractures

“…Radiographic signs of SLD include widening of the scapholunate interval (>2 mm), a scapholunate angle greater than 70 , discontinuity in Gilula's lines, and the presence of a scaphoid ring sign. [35][36][37] Dynamic imaging, including PA grip views, is typically difficult to obtain with a concomitant distal radius fracture. Imaging should be adequate such that the scapholunate angle and the scapholunate interval can be measured.…”