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European Radiology
Published in: European Radiology 3/2016

01-03-2016 | Musculoskeletal

Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography

Authors: A. Klempka, M. Wagner, S. Fodor, K. J. Prommersberger, M. Uder, R. Schmitt

Published in: European Radiology | Issue 3/2016

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Abstract

Objectives

To evaluate the prevalence of injuries of the scapholunate and lunotriquetral interosseous ligaments (SLIL, LTIL) as well as the triangular fibrocartilage complex (TFCC) in intra-articular distal radius fractures (iaDRF).

Methods

Two hundred and thirty-three patients with acute iaDRF underwent MDCT arthrography. The SLIL and LTIL were described as normal, partially or completely ruptured. Major injuries of the SLIL were defined as completely ruptured dorsal segments, those of the LTIL as completely ruptured palmar segments. The TFCC was judged as normal or injured. Interobserver variability was calculated. Injury findings were correlated with the types of iaDRF (AO classification).

Results

In 159 patients (68.2 %), no SLIL injuries were seen. Minor SLIL injuries were detected in 54 patients (23.2 %), major injuries in 20 patients (8.6 %). No correlation was found between the presence of SLIL lesions and the types of iaDRF. Minor LTIL injuries were seen in 23 patients (9.9 %), major injuries in only 5 patients (2.2 %). The TFCC was altered in 141 patients (60.5 %). Interobserver variability was high for MDCT arthrography in assessing SLIL and TFC lesions, and fair for LTIL lesions.

Conclusion

In iaDRF, prevalence of major injuries of the most relevant SLIL is about 9 % as evaluated with CT arthrography.

Key Points

• The C-shaped SLIL is built of dorsal, middle and palmar segments.
• In iaDRF, major SLIL injuries are associated in 8.6 % of the cases.
• In iaDRF, the SLIL remains intact in 68.3 % of the cases.
• IaDRF and SLIL ruptures can comprehensively be depicted with MDCT arthrography.
• A three-compartment approach is recommended to assess intrinsic ligaments and the TFCC.
Literature
1.
2.
Singer BR, McLauchlan GJ, Robinson CJ (1998) Epidemiology of fractures in 15 000 adults. The influence of age and gender. J Bone Joint Surg (Br) 80:243–248CrossRef
3.
Schneiders W, Amlang M, Rammelt, Zwipp H (2005) Frequency of acute and chronic scapholunate dissociation in distal radius fractures. Appropriate treatment plan (German). Unfallchirurg 108:715–720CrossRefPubMed
4.
Sokolow C, Saffar P (2001) Anatomy and histology of the scapholunate ligament. Hand Clin 17:77–81PubMed
5.
Totterman SM, Miller RJ (1996) Scapholunate ligament: normal MR appearance on three dimensional gradient-recalled echo images. Radiology 200:237–241CrossRefPubMed
6.
Berger RA (1996) The gross and histologic anatomy of the scapholunate interosseous ligament. J Hand Surg [Am] 21:170–178CrossRef
7.
Berida S, Wolfe SW (2003) Anatomy biomechanics, and natural history of scapholunate interosseous ligament injuries. Hand Clin 8:191–199CrossRef
8.
Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg [Am] 14:594–606CrossRef
9.
Forward DP, Lindau TR, Melsom DS (2007) Intracarpal Ligament Injuries Associated with Fractures of the distal part of the radius. J Bone Joint Surg Am 89:2334–2340CrossRefPubMed
10.
Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple L (1996) Intracarpal soft tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 78:357–365PubMed
11.
Gunal L, Ozaksoy D, Altay T, Satoglu IS, Kazimoglu C, Sener M (2013) Scapholunate dissociation associated with distal radius fracture. Eur J Ortoph Surg Traumatol 23:877–881CrossRef
12.
Lindau T, Arner M, Hagberg L (1997) Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg (Br) 22:638–643CrossRef
13.
Richards RS, Bennett JD, Roth JH, Milne K (1997) Arthroscopic Diagnosis of Intra-articular Soft Tissue Injuries Associated with Distal Radial Fractures. J Hand Surgery Am 22:772–776CrossRef
14.
Megerle K, Poehlmann S, Kloeters O, Germann G, Sauerbier M (2011) The significance of conventional radiographic parameters in the diagnosis of scapholunate ligament lesions. Eur Radiol 21:176–181CrossRefPubMed
15.
Schmitt R, Froehner S, Coblenz G, Christopoulos G (2006) Carpal instability. Eur Radiol 16:2161–2178CrossRefPubMed
16.
Kwon BC, Choi SJ, Song SY, Baek SH, Baek GH (2011) Modified carpal stretch test as a screening test for detection of scapholunate interosseous ligament injuries associated with distal radial fractures. J Bone Join Surg Am 93:855–862CrossRef
17.
Dornberger JE, Rademacher G, Mutze S, Eisenschenk A, Stengel D (2015) Accuracy of simple plain radiographic signs and measures to diagnose acute scapholunate ligament injuries of the wrist. Eur Radiol. doi:10.​1007/​s00330-015-3776-2 PubMed
18.
Rosenthal DI, Schwartz M, Phillips WC, Jupiter J (1983) Fracture of the radius with instability of the wrist. Am J Roentgenol 141:113–116CrossRef
19.
Mohr A, Guermazi A, Genant HK (2003) Value of sonography of the scapholunate ligament. Am J Roentgenol 181:275–277CrossRef
20.
Schädel-Höpfer M, Iwinska-Zelder J, Boehringer G, Braus T, Klose KJ, Gotzen L (2001) MRI versus arthroscopy in the diagnosis of scapholunate ligament injury. J Hand Surg (Br) 26:17–21CrossRef
21.
Blum A, Bresler F, Voche P, Merle M, Regent D (1996) CT-arthrography of the wrist. In: Gilula LA, Yin Y (eds) Imaging of the wrist and hand. WB Saunders Company, Philadelphia, pp 384–400
22.
Schmitt R, Christopoulos G, Meier R et al (2003) Direct MR arthrography of the wrist in comparison with arthroscopy: a prospective study on 125 patients. (German) RoFo 175:911–919CrossRefPubMed
23.
Theumann N, Favarger N, Schnyder P, Meuli R (2001) Wrist ligament injuries: value of post-arthrography computed tomography. Skeletal Radiol 30:88–93CrossRefPubMed
24.
Schmid MR, Schertler T, Pfirrmann CH et al (2005) Interosseous ligament tears of the wrist: comparison of multi detector row CT arthrography and MR imaging. Radiology 237:1008–1013CrossRefPubMed
25.
Hohendorff B, Eck M, Mühldorfer M, Fodor S, Schmitt R, Prommersberger KJ (2009) Palmar wrist arthroscopy for evaluation of concomitant carpal lesions in operative treatment of distal intraarticular radius fractures. Handchir Mikrochir Plast Chir 41:295–299CrossRefPubMed
26.
27.
Jupiter JB, Fernandez DL (1997) Comparative classification for fractures of the distal end of the radius. J Hand Surg 22:563–571CrossRef
28.
Moser T, Dosch JC, Moussaoui A, Buy X, Gangi A, Dietemann JL (2008) Multidetector CT arthrography of the wrist joint: how to do it. RadioGraphics 28:787–800CrossRefPubMed
29.
Garcia-Elias M (1997) Kinetic analysis of carpal stability during grip. Hand Clin 13:151–158PubMed
30.
Short WH, Werner FW, Green JK, Sutton LG, Brutus JP (2007) Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg [Am] 32:297–309CrossRef
31.
Frykman G (1967) Fracture of the distal radius including sequelae–shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand Suppl 108:3+
32.
Schwendenwein E, Wozasek GE, Hajdu S, Vécsei V (2003) Occult scaphoid-lunate dissociation in distal radius fractures. Wien Klin Wochenschr 115:580–583CrossRefPubMed
33.
Gradl G, Neuhaus V, Fuchsberger T et al (2013) Radiographic diagnosis of scapholunate dissociation among intra-articular fractures of the distal radius interobserver reliability. J Hand Surg 38:1685–1690CrossRef
34.
Suzuki D, Ono H, Furuta K et al (2014) Comparison of scapholunate distance measurements on plain radiography and computed tomography for the diagnosis of scapholunate instability associated with distal radius fracture. J Orthop Sci 3:465–470CrossRef
35.
Bille B, Harley B, Cohen H (2007) A comparison of CT Arthrography of the wrist to findings during wrist arthroscopy. J Hand Surg 32:834–841CrossRef
36.
Welling RD, Jacobson JA, Jamadar DA, Chong S, Caoili EM, Jebson PJ (2008) MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. Am J Roentgenol 190:10–16CrossRef
37.
Arora S, Grover SB, Batra S, Sharma VK (2010) Comparative evaluation of postreduction intra-articular distal radial fractures by radiographs and multidetector computed tomography. J Bone Joint Surg Am 92:2523–2532CrossRefPubMed
38.
Lorenzen M, Wedegärtner U, Weber C, Adam G, Lorenzen J (2011) Postoperative monitoring of distal intraarticular radial fractures treated with osteosynthesis by means of multislice CT. Fortschr Roentgenstr 183:120–125CrossRef
39.
Cole RJ, Bindra RR, Evanhoff BA, Gilula LA, Yamaguchi K, Gelberman RH (1997) Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg [Am] 22:792–800CrossRef
40.
Viegas SF, Patterson RM, Peterson PD et al (1990) Ulnar-sided perilunate instability: an anatomic and biomechanic study. J Hand Surg [Am] 15:268–278CrossRef
41.
42.
Reagan DS, Linscheid RL, Dobyns JH (1984) Lunotriquetral sprains. J Hand Surg [Am] 9:502–514CrossRef
43.
Cerezal L, de Dios Berna-Mestre J, Canga A et al (2012) MR and CT arthrography of the wrist. Semin Musculoskelet Radiol 16:27–41CrossRefPubMed
44.
Theumann NH, Pfirrmann CW, Antonio GE et al (2003) Extrinsic carpal ligaments: normal MR arthrographic appearance in cadavers. Radiology 226:171–179CrossRefPubMed
45.
Cerny M, Marlois R, Theumann N et al (2013) 3-T direct MR arthrography of the wrist: value of finger trap distraction to assess intrinsic ligament and triangular fibrocartilage complex tears. Eur J Radiol 82:e582–e589CrossRefPubMed
46.
Metz VM, Mann FA, Gilula LA (1993) Lack of correlation between site of wrist pain and location of noncommunicating defects shown by three-compartment wrist arthrography. Am J Roentgenol 160:1239–1243CrossRef
47.
Linkous MD, Pierce SD, Gilula LA (2000) Scapholunate ligamentous communicating defects in symptomatic and asymptomatic wrists: characteristics. Radiology 216:846–850CrossRefPubMed
48.
Kitay A, Wolfe SW (2012) Scapholunate instability: current concepts in diagnosis and management. J Hand Surg 37:2175–2196CrossRef
49.
Metadata
Title
Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography
Authors
A. Klempka
M. Wagner
S. Fodor
K. J. Prommersberger
M. Uder
R. Schmitt
Publication date
01-03-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3871-4

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