Intercarpal Ligament Injuries Associated with Distal Radius Fractures: Relation with the Radiographic Findings and Arthroscopic Treatment

Jong-Pil Kim; Young-Ho Park

doi:10.4055/jkoa.2011.46.4.294

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Kim and Park: Intercarpal Ligament Injuries Associated with Distal Radius Fractures: Relation with the Radiographic Findings and Arthroscopic Treatment

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(4): 294-302.

Published online: 31 August 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.4.294

Intercarpal Ligament Injuries Associated with Distal Radius Fractures: Relation with the Radiographic Findings and Arthroscopic Treatment

Jong-Pil Kim, M.D., Young-Ho Park, M.D.

Department of Orthopaedic Surgery, Dankook University School of Medicine, Cheonan, Korea.

Correspondence to: Jong-Pil Kim, M.D., Ph.D. Department of Orthopedic Surgery, Dankook University School of Medicine, 359, Manghyangro, Dongnam-gu, Cheonan 330-715, Korea. TEL: +82-41-550-3919, FAX: +82-41-550-3094, kimjp@dankook.ac.kr

Received 7 November 2010 Accepted 7 March 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to analyze the relationship between intercarpal ligament injuries associated with distal radius fracture and the fracture patterns and radiologic parameters, and to report on the clinical results of arthroscopic treatment for these injuries.

Materials and Methods

Fifty-two patients who underwent arthroscopic surgery for intercarpal ligaments injuries associated with distal radius fracture and who had a minimum 1 year follow-up were enrolled. There were 44 patients who sustained scapholunate interosseous ligament injury (SLIL) and 30 patients who sustained lunotriquetral interosseous ligament (LTIL) injury. Among them, 22 patients had both SLIL and LTIL injuries. The carpal ligament injuries were graded according to the Geissler classification and they treated with arthroscopic debridement only for a grade I and II injury and arthroscopic reduction and percutaneous pinning for a grade III and IV injury. The patients were divided into two groups and we assessed the functional and radiological outcomes: Group 1 consisted of the patients with a grade I and II injury and group 2 consisted of the patients with a grade III and IV injury.

Results

The preoperative mean radial inclination of group 2 with lunotriquetal interosseous ligament injury was 15.1±9.9°, which was significantly different from 20.4±5.1° of group 1, and the extra-articular type injury was more common in group 2 (p<0.05). On the follow-up radiographs, the mean scapholunate interval measured 2.1±0.5 mm in group 1 and 1.7±0.5 mm in group 2, which was significantly different (p<0.05).

Conclusion

The grade of LTIL injury combined with distal radius fractures is associated with the loss of radial inclination and the extra-articular fracture type at the time of initial presentation. Complete tears of the SLIL can be stabilized with arthroscopic reduction and percutaneous pinning.

Keywords: scapholunate interosseous ligament, lunotriquetral interosseous ligament, distal radius fracture, arthroscopic reduction, percutaneous pinning

Figures and Tables

Figure 1

(A) Preoperative radiographs of a 30-year-old man showed an AO type C2 distal radius fracture of his wrist. (B) Midcarpal view showed a grade III scapholunte interosseous ligament injury according to the Geissler classification system.5) (C) The scapholunate joint was fixated with a K-wire under arthroscopic control. (D) Twenty-four month follow-up radiograph showed normal carpal alignment without carpal dissociation, and (E) which was demonstrated by second-look midcarpal arthroscopy. Sc, scaphoid; Lu, lunate; Cp, capitate.

Figure 2

(A) Preoperative radiographs of a 37-year-old man showed an AO type A3 distal radius fracture of his wrist. (B) Midcarpal view showed a grade III lunotriquetral interosseous ligament injury according to the Geissler classification. (C) The lunotriquetral interosseous ligament injury was treated with trans-lunotriquetral K-wire fixation after debridement under arthroscopy. (D) Fifteen month follow-up radiograph and (E) second-look arthroscopy showed normal carpal alignment without instability. Tq, triquetrum; Lu, lunate.

Figure 3

(A) Preopeative radiographs of a 42-year-old woman showed an AO type A3 distal radius fracture of her wrist. (B) The scapholunate interosseous ligament was considered as grade II injury. (C) Eighteen month follow-up radiograph after arthroscopic debridement without pinning showed static carpal instability with a 2.8 mm scapholunate gap. Sc, scaphoid; Lu, lunate.

Table 1

Prevalence of Intercarpal Ligaments and TFCC Injuries Associated with Distal Radius Fractures

TFCC, triangular fibrocartilage complex.

Table 2

Arthroscopic Classification of the Intercarpal Ligament Injuries

From Geissler et al.5)

Table 3

Artrhoscopic Grades of Scapholunate and Lunotriquetral Interosseous Ligament Injuries

SLIL, scapholunate interosseous ligament; LTIL, lunotriquetral interosseous ligament.

Table 4

Radiographic Variables at Initial Presentation

Table 5

Radiographic Measurements at the Last Follow-up

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