Lunotriquetral Ligament Injuries Research Articles

The Use of Cone-Beam Computed Tomography (CBCT) Arthrography for Wrist Ligamentous Injuries - A Diagnostic Test Accuracy Meta-analysis.

Background: Diagnosis of ligamentous wrist injuries can be challenging with the absence of dynamic instability on radiographs. Our aim was to evaluate the accuracy of cone-beam computed tomography (CBCT) arthrography in diagnosing scapholunate ligament (SLL), lunotriquetral ligament (LTL) and triangular fibrocartilage complex (TFCC) injuries. Methods: A systematic review and literature search were conducted in compliance with Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) and registered at the International Prospective Register of Systematic Reviews, PROSPERO (CRD42024517655). A mixed-effects logistic regression bivariate model was used to estimate summary sensitivity and specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were constructed to determine diagnostic accuracy of CBCT arthrography. Results: We identified five studies assessing the accuracy of CBCT arthrography against wrist arthrography or intraoperative findings as reference standard. The pooled estimates for sensitivity and specificity of CBCT arthrography was 93% (95% CI 40-100) and 91% (95% CI 81-96) for SLL injuries, 83% (95% CI 37-98) and 64% (95% CI 42-81) for LTL injuries and 78% (95% CI 57-91) and 80% (95% CI 54-93) for TFCC injuries. The area under the curve was 0.91 (95% CI 0.89-0.94), showing an excellent diagnostic accuracy of CBCT arthrography in SLL injuries. CBCT arthrography had an estimated mean effective dose of 3.2 mSv (2.0-4.8). Conclusions: Our study confirms that CBCT arthrography has an excellent diagnostic accuracy for wrist ligamentous injuries with comparably high sensitivity to conventional arthrography and a better specificity. While further studies with more robust methodology are required to support its implementation in clinical practice, our analysis shows that it is a reliable option and has a promising future. Level of Evidence: Level III (Diagnostic).

Arthroscopic Thermal Shrinkage of Lunotriquetral Ligament Incomplete Tear without Triangular Fibrocartilage Complex Perforation

Abstract Background Few studies have reported the clinical results of arthroscopic debridement and thermal shrinkage for partial lunotriquetral (LT) ligament injury. Purpose We estimated the outcomes of arthroscopic thermal shrinkage of a traumatic LT ligament incomplete tear without triangular fibrocartilage complex (TFCC) perforation. Methods We evaluated the results of 24 patients. The mean follow-up was 16 months. Radiographs were examined for ulnar variance (UV) and radioulnar distance on a true lateral radiograph, and wrist function was assessed based on grip strength, Mayo wrist score, and Disabilities of the Arm, Shoulder, and Hand (DASH) score, both pre- and postoperatively. Results On preoperative magnetic resonance imaging (MRI), no obvious LT ligament tear was observed in any of the patients. The preoperative LT shear test was positive in 19 cases, while the LT ballottement test was positive in 18 cases and the ulnar stress test in 16 cases. Preoperatively, the average radiographic UV was 2.1 mm and the average radioulnar distance was 0.9 mm. The LT tear type was a flap tear in 22 cases and bucket handle tear in 2 cases arthroscopically. The visual analog pain scale score improved postoperatively (from 7.5 to 0.4). The average grip strength improved from 72.7% preoperatively to 89.8% postoperatively. The Mayo wrist score was excellent/good in 6/15 cases and fair in 3 cases, with the scores ranging from 68 to 87. The average DASH score improved from 36.8 to 7. Conclusion We should be careful to differentiate LT ligament tears from TFCC lesions in the cases with ulnar wrist pain, because LT ligament tears may not be detected by MRI. Arthroscopic thermal shrinkage for traumatic LT ligament tear can be an effective treatment. Level of Evidence Level IV.

Outcomes Following Surgical Interventions for Isolated Lunotriquetral Interosseous Ligament Injuries: A Systematic Review.

Ulnar-sided wrist pain can be attributed to various bony and ligamentous structures. The purpose of this review is to compare outcomes following surgical interventions for isolated lunotriquetral (LT) interosseous ligament injuries in adults. We assessed 202 procedures from 9 retrospective case series studies of low to moderate quality based on the Structured Effectiveness Quality Evaluation Scale. The comparative outcomes (ie, range of motion, pain, strength, quality of life, complications, return to work, and patient satisfaction) were aggregated and categorized under arthrodesis, capsulodesis, ligament repairs and reconstruction, and ulna shortening osteotomy procedures. Although the comparison of outcomes was largely inconclusive due to the heterogeneity and the omission of preoperative characteristic data, we did observe higher complications and reoperation rates post LT arthrodesis. It is recommended that all outcomes be standardized and presented uniformly with best practices developed to better characterize the injury's severity and integrity in future studies.

Occult Lunotriquetral Ligament Injuries in Adolescent Golfers.

Publications on lunotriquetral interosseous ligament (LTIL) injuries among adolescent professional golfers are scarce. Inconclusive clinical and radiographic imaging in rendering a definitive treatment may inform the lack of documentation in literature. In this case study, we present three case series of highly competitive adolescent golfers who presented with persistent and intractable ulnar-sided wrist pain. While the physical examination was clinically suspicious for lunotriquetral (LT) ligament injury, plain radiographs and MRI imaging did not elucidate the cause. The diagnosis was confirmed solely via wrist arthroscopy. Although most ulna-sided wrist pain can be treated conservatively, without a proper diagnosis, a missed LTIL injury can be disastrous to an adolescent golfers' future. This case series aims to create awareness of the diagnosis and stress the advantages of utilising wrist arthroscopy. Level of Evidence: Level V (Therapeutic).

Diagnosis and Management of Lunotriquetral Ligament Injuries.

The standard of care for lunotriquetral ligament injuries is evolving. An understanding of the mechanics of the lunotriquetral ligament and its role in carpal kinematics is critical when deciding how to treat these injuries. Treatment for these injuries varies from nonoperative to wrist arthroscopy with thermal capsulodesis and/or repair to reconstruction or limited arthrodesis. This article provides a review of the anatomy, pathomechanics, evaluation, and ultimately treatment of lunotriquetral ligament injuries. Although lunotriquetral ligament injuries can occur in isolation, injuries to the lunotriquetral ligament are often viewed as a component of other injury patterns to the intrinsic and extrinsic ligaments of the wrist. Static volar intercalated segment instability typically occurs when the dorsal radiocarpal ligament is also compromised. If nonoperative treatment fails, arthroscopy is the gold standard for diagnosis even with improving imaging modalities. Recently, authors have proposed employing the technique of ulnar-shortening osteotomy in those with ulnar negative variance and the absence of an impaction lesion. Other newer techniques included bone-ligament-bone reconstruction for chronic, static instability. LT injuries rarely occur in isolation. Most injuries involving the lunotriquetral ligament can be treated nonoperatively. Those individuals with persistent pain should be treated with a diagnostic wrist arthroscopy. Primary repairs are indicated in those with an acute, complete tear. In chronic, static instability, ligament reconstruction has been shown to improve wrist function and decrease pain.

Arthroscopic Management of the Hamate Proximal Pole Arthrosis.

In this retrospective study, all patients with arthrosis of the proximal pole of the hamate encountered in a 10-year period treated with arthroscopy were reviewed. Patient demographics, arthroscopic details, associated injuries, and procedures were reviewed. Functional and patient-reported clinical outcomes after arthroscopic osteochondroplasty were analyzed. An analysis of 39 patients who underwent arthroscopic osteochondroplasty showed a type II lunate prevalence of 87.2%. On wrist arthroscopy, a triangular fibrocartilaginous complex tear was the most common diagnosis (64.1%), followed by scapholunate ligament tear (61.5%) and lunotriquetral ligament tear (35.9%). All patients were managed arthroscopically with 100% procedural success. Average follow-up of 42.8 ± 37.7 months showed statistically significant improvements in the visual analog score and Mayo wrist score postoperatively (P < 0.01). Three patients (7.7%) failed the procedure at a mean of 23 ± 31.4 months. Risk factors for salvage operations were nondominant wrist involvement 100% (P = 0.04), lunotriquetral ligament injury 100% (P = 0.04), the absence of triangular fibrocartilaginous complex injury 100% (P = 0.04), and the presence of scapholunate advanced collapse 100% (P < 0.01). Wrist arthroscopy is valuable for accurately diagnosing and treating hamate arthrosis and identifying a wide variety of pathologies associated. This study showed arthroscopic osteochondroplasty produced satisfactory clinical results. Furthermore, the presence of scapholunate advanced collapse wrist offers its prognostic value in determining treatment failure.

Outcomes after Bone-Ligament-Bone Intercarpal Ligament Reconstruction.

Numerous surgical reconstructive techniques have been described for chronic scapholunate and lunotriquetral interosseous ligament instability. The authors retrospectively reviewed 16 consecutive patients who underwent bone-ligament-bone reconstruction for scapholunate or lunotriquetral intraosseous ligament predynamic and dynamic instability at a single tertiary care institution from 2013 to 2019. Clinical and radiographic outcomes, and complications, were recorded. Eleven patients had bone-ligament-bone reconstruction for scapholunate ligament injuries and five for lunotriquetral instability. Fourteen patients (87.5 percent) underwent diagnostic arthroscopy before bone-ligament-bone reconstruction, with nine of 14 having grade 3 and four of 14 having grade 4 injury. Capitohamate bone-ligament-bone grafts were used in nine patients (56 percent) and the graft was taken from Lister tubercle in seven (44 percent). The average age at surgery was 37 years. The average follow-up was 60.6 weeks. There were no significant differences between preoperative and postoperative radiographic parameters. Median postoperative wrist flexion was 45 degrees, and mean postoperative wrist extension was 53 degrees, which were significantly less than contralateral flexion (85 degrees; p < 0.0001) and extension (78 degrees; p < 0.0001). Thirty-eight percent of patients complained of persistent pain at final follow-up, and two patients (13 percent) underwent salvage procedures, both at approximately 6.5 months after the index reconstruction. Short-term outcomes of bone-ligament-bone reconstruction for early-stage scapholunate and lunotriquetral ligament injuries reveal many patients with residual postoperative wrist pain and disability, and almost uniform limitations in flexion-extension motion. Therapeutic, IV.

LT Ligament Tears.

Lunotriquetral (LT) ligament injuries are uncommon, however, should be considered in patients with ulnar-sided wrist pain. LT injuries are often associated with other injuries but can occur in isolation. Understanding the anatomy and pathomechanics will aid in making the diagnosis. Similar to other injuries, a thorough history and focused physical examination is critical. Radiographs may show normal findings; however, advanced imaging can support the diagnosis. Arthroscopy remains the gold standard for diagnosis. Most patients do well with conservative management; however, injury acuity and severity will direct surgical management. Anatomy, pathophysiology, and treatment options are discussed.

Arthroscopic Lunotriquetral Ligamentoplasty, from the Cadaver Lab to the Clinical Practice

Abstract Introduction There has been an increase in the diagnosis of injuries to the intrinsic ligaments of the wrist due to the more widespread use of arthroscopy in the treatment of patients with musculoskeletal wrist pain, and arthroscopy is particularly very helpful to determine the etiology of these lesions at the ulnar level. The treatment of lunotriquetral ligament injuries encompasses different techniques with results that are little reproducible. Ligament reconstruction through tendon grafting has shown favorable results, but it involves extensive open approaches that lead to a slower recovery a lower range of joint motion due to the excess of scar tissue. The objective of the present study is to describe the performance, in a cadaver, of a minimally-invasive lunotriquetral and secondary-stabilizer ligamentoplasty and its application in a representative clinical case. Material and Methods A preliminary study of six specimens in which a lunotriquetral and secondary-stabilizer ligamentoplasty was performed consecutively through a free tendon graft with arthroscopic assistance. We proceeded to recreate the complete ligament injury, and to perform an assessment of lunotriquetral instability according to the Geissler classification and an arthroscopic ballottement test. We describe the surgical technique, ligament stability after the ligamentoplasty, and the subsequent anatomical dissection, assessing the anatomical structures susceptible to iatrogenic injury. We also describe the application of the technique in one case, comparing the clinical parameters before and after the procedure: range of motion of the joint, strength, pain and the shortened version of the Disabilities of the Arm, Hand, and Shoulder (QuickDASH) questionnaire. Results The ligamentoplasties performed showed recovery of the stability of the lunotriquetral interval assessed according to the Geissler classification and the arthroscopic ballottement test. In the dissection of the specimens, no iatrogenic lesions were found in the tendons or the surfaces of the mediocarpal and radiocarpal joints. The average distances between the nearest bone tunnels and nerves were of 7.3 mm for the sensory branch of the ulnar nerve, of 3.6 mm for the posterior interosseous nerve, and of 4.5 mm for the ulnar neurovascular bundle. No fractures were observed in the tunnelled bones. In the clinical case herein presented, six months after the intervention, there was an improvement in strength and preoperative pain, with a slight decrease in the joint range of motion (15% compared to the contralateral joint). Conclusions The lunotriquetral ligamentoplasty herein described could contribute to the biomechanical restoration of the carpus and be an option for recosntruction in selected cases. Its performance through minimally-invasive techniques, and the use of a free tendon graft together with specific rehabilitation should be considered to optimize the outcomes.

Outcomes Following Surgical Treatment of Hamate Arthrosis Lunotriquetral Ligament Injuries.

An institutional review board-approved study of the functional outcomes of patients after surgical treatment of hamate arthrosis lunotriquetral ligament tear (HALT) lesions was conducted. In all, 21 wrists in 19 patients underwent arthroscopic, open, or combined treatment of HALT lesions. Seven patients underwent isolated hamate debridement and 14 had concomitant procedures to address lunotriquetral pathology. Nineteen wrists underwent procedures to address additional pathology, including triangular fibrocartilage complex, ulnotriquetral ligament split, and scapholunate ligament injuries. Mayo wrist scores increased from 54 to 71. Sixteen patients had no or mild pain postoperatively, compared with none preoperatively. When stratified by lunotriquetral interosseous ligament management, 75% of the limited treatment group (none or debridement) and 78% of the additional treatment group reported improved pain. Three patients underwent additional surgeries for persistent pain. Resection of the proximal pole of the hamate can improve pain and function for patients with ulnar-sided wrist pain secondary to a HALT lesion. Concomitant wrist pathologies should be considered when determining treatment plans.

Arthroscopic dorsal capsulodesis for isolated lunotriquetral interosseous ligament injuries.

We assessed the outcomes of isolated lunotriquetral ligament injuries in ten patients who underwent arthroscopic dorsal capsulodesis. Data from patient records, radiologic images and arthroscopic video records were evaluated. The patients were evaluated for ulnar-sided wrist pain with history and physical examination. Preoperative radiographs and MRIs for pain aetiology were assessed. The patients underwent arthroscopic dorsal capsulodesis and were evaluated 29months (range 19-45) after surgery. Nine patients returned to their original jobs. In one patient pain was aggravated with heavy activities. Mean scapholunate angle was 44°. There were significant improvements postoperatively in pinch and grip strength and MAYO wrist, patient-reported wrist evaluation and pain scores. The wrist flexion-extension and the radial ulnar deviation were significantly improved compared with the contralateral hand. We conclude that arthroscopic dorsal capsulodesis offers effective management for isolated lunotriquetral interosseous ligament injuries.Level of evidence: IV.

Role of MRI in evaluation of wrist ligament injury

Aims The aim of the study was to evaluate the role of MRI in detection of wrist ligament injury. Patients and methods We performed coronal PDW, coronal PDWSPIR, coronal T2-weighted, coronal gradient, and coronal STIR in 20 patients complaining of wrist pain. The authors assessed images for the integrity of lunotriquetral ligament (LTL), scapholunate ligament (SLL), and TFCC tears. Then the authors compared imaging findings with arthroscopic data in 16 patients who underwent arthroscopy (gold standard). Results A total of 12 TFCC tears were detected arthroscopically, whereas nine were found on MRI. MRI sensitivity in the diagnosis of TFCC tears was 92.31%. Eight SLL tears were found arthroscopically, whereas three tears were detected on MRI. MRI sensitivity in detecting SLL tears was 42.86%. Three LTL tears were diagnosed arthroscopically, whereas we found two LTL tears on MRI. MRI sensitivity in detecting LTL tears was 33.33%. Conclusion MRI has an excellent role in the diagnosis of the TFCC tear with high sensitivity and specificity but less accurate in the evaluation of SLL and LTL injuries.

Scapholunate, lunotriquetral and TFCC ligament injuries associated with intraarticular distal radius fractures: Arthroscopic assessment and correlation with fracture types

The aim of this study was to evaluate the prevalence of arthroscopic scapholunate (SL) and/or lunotriquetral (LQ) laxity and triangular fibrocartilaginous complex (TFCC) injuries in patients who have an intraarticular fracture of the distal radius and to correlate these lesions with fracture type. Fifty-seven intraarticular radius fractures, whether or not they were associated with an ulnar styloid fracture, were evaluated and treated by arthroscopy. Scapholunate and lunotriquetral ligament injuries were classified according to the EWAS classification. TFCC lesions were assessed according to Palmer's classification. Each injury was documented through preoperative X-rays and a CT scan. Fracture type and soft tissue injury were not significantly associated one to another. Arthroscopic examination revealed at least one soft tissue injury in 39 intraarticular fractures of the distal radius (68.4%). Twenty-five percent of arthroscopic SL laxities (including severe EWAS 3 injuries) were not detected on standard radiographs. Arthroscopic SL laxity was present in 8 of 11 cases (72.7%) of radial styloid fracture and in 15 of 25 cases (60%) of fractures with at least one radial styloid component. There was no association between LQ integrity and fracture type. Ulnar styloid fractures (base or tip) and TFCC lesions were significantly correlated (P<0.0001). The prevalence of soft tissue lesions secondary to intraarticular fractures of the distal radius was 68.4%. However, there was no statistically significant relationship between the different types of radius fractures and soft tissue injuries. On the other hand, ulnar styloid fracture was predictive of TFCC injury.

Intercarpal Ligament Injuries Associated With Distal Radius Fractures.

Injuries to the scapholunate (SL) and lunotriquetral (LT) interosseous ligaments occur in approximately one third of distal radius fractures. The diagnosis of these injuries is challenging because plain radiographs are not reliably diagnostic. Wrist arthroscopy may be the most accurate way to examine and diagnose soft-tissue injuries of the carpus adjacent to a distal radius fracture. Treatment options for SL and LT ligament injuries include open repair and/or percutaneous pinning. Because the natural history of these injuries is unclear, the necessity of diagnosing and treating these SL and LT interosseous ligament defects remains speculative.

Wrist arthroscopy and MRI for the evaluation of scapholunate and lunotriquetral ligaments tear in Kienbock’s disease

Purpose The principal intrinsic wrist interosseous ligaments of the wrist are the scapholunate ligament (SLL) and the lunotriquetral ligament (LTL). Injuries to the wrist ligaments are common and can lead to chronic wrist pain. To our knowledge, the incidence of associated intrinsic wrist ligament pathology in Kienbock’s disease has not been previously described. Herein, we used wrist arthroscopy and MRI for the evaluation of SLL and LTL injury in 40 patients with Kienbock’s disease. Patient and methods The study was based on 40 patients with Kienbock’s disease (stages II, IIIa, and IIIb), 17 women and 23 men. Their age ranged from 13 to 46 years (mean, 31 years and 6 months). All patients underwent MRI followed by wrist arthroscopy for the diagnosis of SLL and/or LTL tear. Results The incidence of isolated SLL tear and combined SLL and LTL tear of the 40 patients with Kienbock’s disease included in this study was 27.5 and 7.5% as evaluated with MRI, respectively, and 35 and 15% as evaluated with wrist arthroscopy, respectively. According to Geissler arthroscopic classification, 75% of SLL injury were of grade I, while 25% were of grade III. Moreover, 50% of the patients with ligamentous injury reported a history of trauma with a mean of 4.4 months interval between the trauma and first presentation. Conclusion This study had proved that Kienbock’s disease is associated with tear of SLL and/or LTL in a significant number of patients among the study group. However, it was difficult to distinguish between the degenerative and traumatic ligament tears.

Association of lunate morphology, sex, and lunotriquetral interosseous ligament injury with radiologic measurement of the capitate-triquetrum joint.

Radiologic presentation of carpal instability at the radial side of the carpus, e.g. scapholunate diastasis following scapholunate interosseous ligament injury, has been studied extensively. By comparison, presentation at the ulnar-sided carpus has not. The purpose of this study was to assess the effects of lunate morphology, sex, and lunotriquetral interosseous ligament (LTIL) status on the radiologic measurement of the capitate-triquetrum joint (C-T distance). Further, we sought to evaluate the diagnostic accuracy of C-T distance for assessing LTIL injuries. We retrospectively identified 223 wrists with wrist radiographs and MR arthrograms with contrast injection. Data collected included sex, lunate morphology and LTIL status from MR arthrography, and C-T distance from radiography. The effects of lunate morphology, sex, and LTIL injury status on C-T distance were evaluated using generalized linear models. Diagnostic performance of C-T distance was assessed by the area under receiver-operator characteristic curve (AUROC). Lunate morphology, sex, and LTIL injury status all had significant effects on C-T distance; wrists with type II lunates, men, and wrists with LTIL injuries had greater C-T distances than wrists with type I lunates, women, and wrists without LTIL injuries, respectively (p<0.01). The diagnostic value of the C-T distance for identifying patients with full-thickness LTIL tears was sufficient for women with type I (AUROC=0.67) and type II lunates (0.60) and good for men with type I (0.72) and type II lunates (0.77). The demonstrated influence of LTIL status on C-T distance supports the use of C-T distance as a tool in assessing for full-thickness LTIL tears.

Scapholunate and perilunate injuries in the athlete.

Scapholunate and perilunate injuries can be difficult to diagnose and treat in the athlete. In this review article, we present the mechanism of injury, evaluation, management, and outcomes of treatment for these injuries. Acute repair of dynamic scapholunate ligament injuries remains the gold standard, but judicious use of a wrist splint can be considered for the elite athlete who is in season. The treatment of static scapholunate ligament injury remains controversial. Newer SL reconstructive techniques that aim to restore scapholunate function without compromising wrist mobility as much as tenodesis procedures show promise in athlete patients. Acute injuries to the scapholunate ligament are best treated aggressively in order to prevent the sequelae of wrist arthritis associated with long-standing ligamentous injury. Acute repair is favored. Reconstructive surgical procedures to manage chronic scapholunate injury remain inferior to acute repair. The treatment of lunotriquetral ligament injuries is not well defined.

Inestabilidad lunopiramidal

Radial-sided wrist instability has historically received greater attention than ulnar-sided instability despite being a relatively frequent pathology. As a result, there is often a delay in correct diagnosis and appropriate treatment. Lunotriquetral ligament injuries can be partial or complete, and the latter may be associated with injury of secondary stabilisers. When these stabilisers are injured a static carpal instability, known as Volar Intercalated Segmentary Instability (VISI), occurs. Among the most common clinical tests used to detect lunotriquetral instability are the ballottement test, described by Reagan, and the shear test, described by Kleinman, although both of them have a low sensitivity and specificity. Several techniques for the diagnosis of these injuries are used, such as X-rays (usually normal if there is no static instability of the carpus), arthrography and magnetic resonance imaging, although wrist arthroscopy is the reference standard for diagnosing these lesions. There is no consensus about which is the optimal treatment of lunotriquetral ligament tears, as the literature consists mostly of retrospective leveliv studies without standardised objective measurements using validated instruments. Furthermore, most of them describe the results of late treatment due these lesions not usually being diagnosed in an acute phase. Among the treatments described are arthroscopic treatment (debridement/thermal shrinkage/pinning the lunotriquetral joint), open repair of the lunotriquetral ligament, soft tissue reconstruction, and lunotriquetral arthrodesis.

Arthroscopic-assisted treatment for athletes with distal radius fractures

Introduction Many studies revealed soft tissue lesions were relatively common finding in young adult patients with distal radius fractures and arthroscopy appears to facilitate diagnosis. If these soft tissue lesions untreated, maybe causes the complications for the long-term outcome and have the inferior score results for high demand wrist. Objectives This presentation used percutaneous or open plating techniques augmented by simultaneous wrist arthroscopy to visualize the articular fractures and thus confirm the fracture alignment post-reduction, also assesses the concurrent associated ligament injuries. Methods Arthroscopy was used to help to reduce distal radius fractures and assess soft tissue injuries in 31 athletes (29 male and 2 female); including 11 baseball players, six basketball players, two gymnasts, seven tennis players, 2 rugby players and 3 football players. The average age of the patients was 28.2 years (range, 19–40). The fractures were treated by reduction under arthroscopic control and percutaneous or open fixation with implants. In our series, soft tissue injuries in wrist fracture of are common. The soft tissue lesions also treated at same operation including debridement, suture repairing or Kischner wires tranfixation. Results Night (29.0%) of the patients had scapholunate (SL) ligament injuries. Eight (23.7%) of the patients suffered lunotriquetral (LT) ligament injuries, and received ligament debridement or Kischner wires fixation of the joint and splinting. A further 10 (33.8%) of the patients exhibited chondral fractures. Additionally, the triangular fibrocartilage complex (TFCC) was torn in 13 (39.0%) of the patients. Finally, 9 (28.8%) of the patients suffered volar carpal ligament injuries. All fractures healed without malunion or nonunion, and at follow-up (more than 48 months), most patients (92%) displayed excellent and good results, based on Mayo modified wrist scores. Conclusion We believe that arthroscopic reduction may be considered for distal radius fractures because this approach can use a minimal operation to achieve acceptable restoration of fractures as well as assessment and management of soft tissue lesions in high demand athletes.

Management of lunotriquetral instability: a review of the literature.

Lunotriquetral ligament injury is a relatively common cause of ulnar-sided wrist pain. Injury ranges from partial stable ligament tears to extensive perilunate instability. Clinical decision-making largely depends on the chronicity, instability and cause of the ligament injury. Conservative treatment is generally regarded as first choice of treatment of mild lunotriquetral instability; however, outcome studies on conservative treatment are lacking. Temporary arthroscopic pinning and/or debridement are minimally invasive procedures of preference. In the case of more dissociative injury, surgical interventions may be performed. The literature suggests that soft tissue reconstruction is an effective procedure in this group. Arthrodesis of the lunotriquetral joint is associated with high rates of non-union (up to 57%) and the indications for surgery should therefore be very clear. Methodological issues make it hard to draw firm conclusions from the data. Studies on the effectiveness of conservative management and prospective comparative studies will further improve clinical decision-making in lunotriquetral instability. N/A.