Background: Soft-tissue injuries of the wrist are often not
recognized in patients with distal radial fractures, yet scapholunate injuries
have been reported to occur in association with as many as 54% of distal
radial fractures. The true prevalence and natural history of intercarpal
ligament injury are not known.
Methods: This prospective observational study assessed the
prevalence and one-year outcome of intercarpal ligament injuries in
non-osteoporotic patients with displaced fractures of the distal part of the
radius. The study group consisted of fifty-one patients (twenty-seven women
and twenty-four men) with a median age of forty-one years (range, twenty to
fifty-seven years). Patients underwent standard fracture treatment and, in
addition, wrist arthroscopy was performed to identify associated carpal
injuries. No ligamentous injuries were treated. Patients were reviewed at one
year and underwent physical and radiographic evaluation. Patients were
analyzed according to the status of the scapholunate ligament at the time of
the injury and were graded with use of a modification of the Geissler
classification system: Group I consisted of ten patients with a grade-3
scapholunate ligament injury, and Group II consisted of forty-one patients
with a grade-0, 1, or 2 injury.
Results: Patients with an increase in ulnar variance of >2 mm at
the time of the injury had a fourfold increase in the risk of sustaining a
grade-3 scapholunate ligament injury (p = 0.01). Radiographically, at one
year, patients in Group I (grade-3 injuries) had a greater amount of static
and dynamic scapholunate dissociation and a significantly greater increase in
the scapholunate angle in comparison with the uninjured wrist (p = 0.006) than
did those in Group II. Intra-articular fractures were associated with a
twofold increase in the prevalence of scapholunate dissociation as seen
radiographically at one year. The prevalence of subjective pain on examination
was significantly greater in Group I than in Group II (p = 0.009). There were
no significant differences between the two groups with respect to objective
outcome according to range of motion and hand grip and tip pinch strengths.
Lunotriquetral injuries were uncommon and did not correlate with the
scapholunate injuries, fracture grade, or configuration.
Conclusions: Grade-3 scapholunate ligament tears can be associated
with ulnar positive variance at the time of initial presentation of a distal
radial fracture and can be associated with more scapholunate joint pain at one
year. These injuries could lead to scapholunate dissociation at the time of
follow-up, particularly in patients with intraarticular fractures.
Level of Evidence: Prognostic Level I. See Instructions
to Authors for a complete description of levels of evidence.