Scapholunate Diastasis in Distal Radius Fractures: Fracture Pattern Analysis on CT Scans

Abstract

Objectives Our understanding of distal radius fractures with concomitant scapholunate (SL) diastasis primarily comes from plain radiographs and arthroscopy. The clinical implications of SL diastasis are not clear. The aim of this study is to describe fracture characteristics of distal radius fractures on computed tomography (CT) scans in patients with distal radius fractures and static SL diastasis.

Methods We queried our institutional databases to identify patients who were treated for a distal radius fracture, had a CT scan with a wrist-protocol, and static SL diastasis on their CT scan. Our final cohort consisted of 26 patients. We then collected data on their demographics, injury, treatment, evaluated injury patterns, and measured radiographic SL characteristics. Our study cohort consisted of 11 men (42%) and almost half of our cohort (n = 12; 46%) had a high-energy mechanism of injury. The majority of the patients (n = 20; 77%) had operative treatment for their distal radius fracture and two patients (7.7%) had operative treatment of their SL injury.

Results The mean SL distance was 3.5 ± 1.1 mm. Twenty patients (77%) had an intra-articular fracture. In these patients, we observed three patterns: (1) scaphoid facet impaction; (2) lunate facet impaction; and (3) no relative impaction. We observed other injury elements including rotation of the radial styloid relative to the lunate facet and partial carpal subluxations.

Conclusion Static SL dissociation in the setting of distal radius fractures may be an indication of a complex injury of the distal radius, which may not be directly apparent on plain radiography. If these radiographs do not demonstrate impaction of the lunate or scaphoid facet, a CT scan may be warranted to have a more detailed view of the articular surface.

Level of Evidence This is a Level III, diagnostic study.

Keywords

distal radius fractures - injury pattern - CT scan - scapholunate diastasis

Note

The work was performed at the Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States.

Ethical Approval

The Institutional Review Board of our institution approved this study under protocol 2009P001019.

Authors' Contributions

This study represents a great deal of effort, resources, and dedication on the part of the authors in reviewing and reconstructing all cases, reviewing the literature, and performing statistical analyses. All authors have participated in a material way to the elements below:

S.O., N.C.C., J.B.J., C.S.M., and F.W.B participated in the study design. S.O. and N.C.C. gathered study Data. S.O., N.C.C., J.B.J., C.S.M., and F.W.B. performed data analysis. S.O., N.C.C., J.B.J., C.S.M., and F.W.B. prepared initial draft. S.O. and N.C.C. ensured accuracy of data

• References

• 1 Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996; 78 (03) 357-365
• 2 Forward DP, Lindau TR, Melsom DS. Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am 2007; 89 (11) 2334-2340
• 3 Mudgal C, Hastings H. Scapho-lunate diastasis in fractures of the distal radius. Pathomechanics and treatment options. J Hand Surg [Br] 1993; 18 (06) 725-729
• 4 Mudgal CS, Jones WA. Scapho-lunate diastasis: a component of fractures of the distal radius. J Hand Surg [Br] 1990; 15 (04) 503-505
• 5 Yoshida S, Yoshida K, Sakai K, Nakama K, Shiba N. Frequency of scapholunate ligament injuries associated with distal radius shearing fracture: correlation of fracture patterns and ligament tear. Hand Surg 2015; 20 (03) 440-446
• 6 Akahane M, Ono H, Nakamura T, Kawamura K, Takakura Y. Static scapholunate dissociation diagnosed by scapholunate gap view in wrists with or without distal radius fractures. Hand Surg 2002; 7 (02) 191-195
• 7 Richards RS, Bennett JD, Roth JH, Milne Jr K. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am 1997; 22 (05) 772-776
• 8 Kasapinova K, Kamiloski V. Influence of associated lesions of the intrinsic ligaments on distal radius fractures outcome. Arch Orthop Trauma Surg 2015; 135 (06) 831-838
• 9 Mrkonjic A, Lindau T, Geijer M, Tägil M. Arthroscopically diagnosed scapholunate ligament injuries associated with distal radial fractures: a 13- to 15-year follow-up. J Hand Surg Am 2015; 40 (06) 1077-1082
• 10 Lindau T, Hagberg L, Adlercreutz C, Jonsson K, Aspenberg P. Distal radioulnar instability is an independent worsening factor in distal radial fractures. Clin Orthop Relat Res 2000; (376) 229-235
• 11 Short WH, Werner FW, Green JK, Sutton LG, Brutus JP. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg Am 2007; 32 (03) 297-309
• 12 Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2012; 37 (10) 2175-2196
• 13 Slutsky DJ. Arthroscopic dorsal radiocarpal ligament repair. Arthroscopy 2005; 21 (12) 1486
• 14 Lee SK, Model Z, Desai H, Hsu P, Paksima N, Dhaliwal G. Association of lesions of the scapholunate interval with arthroscopic grading of scapholunate instability via the Geissler classification. J Hand Surg Am 2015; 40 (06) 1083-1087
• 15 Bain GI, Alexander JJ, Eng K, Durrant A, Zumstein MA. Ligament origins are preserved in distal radial intraarticular two-part fractures: a computed tomography-based study. J Wrist Surg 2013; 2 (03) 255-262
• 16 Suzuki D, Ono H, Furuta K. , et al. 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 2014; 19 (03) 465-470
• 17 Gradl G, Neuhaus V, Fuchsberger T, Guitton TG, Prommersberger KJ, Ring D. ; Science of Variation Group. Radiographic diagnosis of scapholunate dissociation among intra-articular fractures of the distal radius: interobserver reliability. J Hand Surg Am 2013; 38 (09) 1685-1690
• 18 Geissler WB, Freeland AE. Arthroscopically assisted reduction of intraarticular distal radial fractures. Clin Orthop Relat Res 1996; (327) 125-134
• 19 Fontes D, Lenoble E, de Somer B, Benoit J. Lesions of the ligaments associated with distal fractures of the radius. 58 intraoperative arthrographies [in French]. Ann Chir Main Memb Super 1992; 11 (02) 119-125
• 20 Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am 1980; 5 (03) 226-241