Radiographic Signs of Static Carpal Instability With Distal End Radius Fractures: Is Current Treatment Adequate?

Abstract

Patients presenting with distal end radius fractures may have concomitant carpal instability due to disruption of the scapholunate ligament. This study examined the incidence of static radiographic signs of carpal instability in patients with distal radial fractures before and after fracture treatment. We performed a retrospective radiographic study of 141 patients presenting to Central Middlesex Hospital, London between January 2002-May 2004 with distal end radius fractures. We used abnormal scapholunate angle as the primary indicator of possible carpal dissociation. Abnormal scapholunate angles were noted in 39% of patients at presentation and 35% of patients after treatment with no statistically significant intra-patient variability. Persistent static radiographic signs of carpal instability are high in this subset of patients. The long-term morbidity of persistent wrist instability may be avoided by early radiological diagnosis with clinical correlation to identify carpal ligament injuries and initiate treatment that addresses both the bony and ligamentous components of the injury.

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

“…However, these are not always clinically relevant. Possibly, ligamentous healing takes place during the immobilization [ 4 , 18 , 19 ]. Nonetheless, some patients receive simultaneous open distal radius fixation and direct SLIL reconstruction [ 20 - 24 ].…”

Management of Intercarpal Ligament Injuries Associated with Distal Radius Fractures

“…Others have shown that patients with abnormal scapholunate angles at the time of presentation may have signs of static scapholunate dissociation at final followup, signifying the high morbidity of these injuries if left untreated. 43 Advocates of arthroscopically assisted fracture reduction techniques for DRF often cite the ability to acutely diagnose and treat SLIL injuries. In a retrospective review of 26 wrists treated exclusively with arthroscopically assisted fracture fixation using K-wires, the authors also treated 19 SLIL and 10 LTIL injuries.…”

Radius Styloid Process Fractures Treated with Break-Away Screws: Two Cases Report

“…Distal radius fractures often have concomitant carpal bone diastases, specifically scapholunate (SL) dissociation due to disruption of the scapholunate ligament [3][4][5]. Bunker et al reported that 39% of the patients with distal radius fractures had abnormal SL angles [5]. Moreover, Pilný et al reported that SL instability associated with type B fracture was found in 25% of the patients [6].…”