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Radiographic Evaluation of Ligament Injuries Associated with Distal Radius Fractures
Sanjay Naran MD, Sameer Shakir BS, Louis Gilula MD, Ronit Wollstein MD
University of Pittsburgh Medical Center
2013-02-28
Presenter: Sanjay Naran MD
Affidavit:
This work, in its entirety, presented the original work of the resident
Director Name: Joseph Losee, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
BACKGROUND:
Despite surgical reduction of distal radius fractures (DRFs), wrist symptoms and functional limitation may persist. This may be secondary to associated ligamentous injuries that remain untreated. We aimed to identify radiocarpal ligamentous changes by comparing the position of the scaphoid within the radioscaphoid joint in normal radiographs to its position following open reduction internal fixation (ORIF) of DRFs.
METHODS:
Measurements were performed in the coronal plane perpendicular to the long axis of the radius; a method validated previously on normal radiographs. Distance between the ulnar border of the radial styloid and the radial border of the scaphoid was measured midway between the tip of the styloid and the scaphoid base (D). To account for scaphoid shape and flexion/extension/rotation, scaphoid width was measured at the same level (W). Measurements were expressed as a ratio (D/W), which was established as the most reliable for evaluating scaphoid shift. Values were compared to normal values using student t-test (p<0.05).
RESULTS:
Fifty radiographs were reviewed. 52% of patients were female. Average age at injury was 47.94±17.94 years. Measurements for fracture group and control group averaged 3.02±1.38mm and 2.05±0.12mm for D, and 10.48±1.66mm and 5.85±1.23mm for W, and 0.30±0.016 and 0.35±0.014 for D/W, respectively. The difference between these groups was significant (p=0.0001).
CONCLUSION:
Despite reduction of DRFs, there persists abnormal positioning of the scaphoid in the radioscaphoid joint. We believe this reflects ligamentous injury and may explain suboptimal results as well as development of wrist osteoarthritis, advocating addressing such injury at the time of reduction.
