Mean Scapholunate Angle Research Articles

Radiological radio-carpal and mid-carpal motion after operative treatment of dorsal radio-carpal fracture dislocations

Radio-carpal fracture dislocations are rare severe injuries typically seen following high energy trauma. This injury is characterized by complete dislocation of the radio-carpal joint with avulsion fracture of dorsal or palmar cortical rim of the distal radius combined with disruption of the radio-carpal ligament complex. The purpose of our study is to assess the radiological motion outcome of the radio-carpal joint after Moneim type 1 radio-carpal fracture dislocations following surgical treatment. Only Moneim type 1 injuries were included in this study. Eight patients with Moneim type 1 injuries were identified by retrospective examination of our fracture registry and included in this study. All patients were initially treated with closed reduction and plaster immobilization. CT scans were performed after reduction. Operative treatment consisted of anatomic reduction of the distal radial rim fractures and fixation with a small T-plate through a dorsal approach. Cancellous bone graft was utilized if necessary to support the articular surface. Repair of the palmar radio-carpal ligament complex was performed through a palmar wrist approach. Antero-posterior, lateral, as well as lateral flexion and extension radiographs were taken at an average follow-up of 4.1 years. Follow-up radiologic evaluation of standard lateral radiograph revealed a mean scapholunate angle of 55.6°. The mean capitolunate angle was found to be −11.6° and the mean radio-capitate angle was 10.5°. The average noted angles in maximum flexion were as follows: radiolunate 15.3°, capitolunate 18° and radiocapitate 30°. The average angles in maximum extension were: radiolunate −23.9°, capitolunate −31° and radiocapitate −55°. At follow-up, arthritic changes were assessed radiographically using the classification described by Knirk and Jupiter. Fifty-six percent of the patients were found to exhibit stage 1 traumatic arthritis, 33% had stage 2 traumatic arthritis and 11% exhibited stage 3 traumatic arthritis with radio-carpal joint space obliteration. Rigid bony fixation and palmar radio-carpal ligament repair of Moneim Type 1 radio-carpal dislocations resulted in preservation of sagittal plane motion of the proximal carpal row in eight of nine cases. Our data suggest that surgical reconstruction of Moneim type 1 injuries is the preferred treatment and usually leads to satisfactory range of motion.

Partial Scapholunate Ligament Injuries Treated With Arthroscopic Debridement and Thermal Shrinkage

To present the early results of arthroscopic debridement and thermal shrinkage using radiofrequency probes for partial (Geissler grades I and II) scapholunate (SL) interosseous ligament injuries of the wrist. Sixteen patients with a mean age of 34 years (range, 18-54 y) presenting with chronic dorsoradial wrist pain unresponsive to initial conservative treatment for a mean period of 12 weeks were included in this study. No patient showed radiologic signs of static dissociation (SL interval, <3.5 mm; mean SL angle, 49 degrees ) before surgery. Diagnostic arthroscopy showed a partial SL tear in 14 patients and redundancy of the ligament in 2. Partial SL tears involved the membranous (proximal) and volar part of the ligament. All lesions were debrided and treated with thermal shrinkage using a bipolar radiofrequency probe. The mean follow-up period was 19 months (range, 9-34 mo). Fourteen patients experienced substantial pain relief whereas in 2 the pain remained unchanged. Eight patients were completely pain free. The mean flexion-extension arc was 142 degrees and the mean grip strength was 78% that of the unaffected side. No patient showed radiologic signs of arthritis or static or dynamic instability after surgery (SL interval remained <3.5 mm; mean SL angle, 53 degrees ). Based on the modified Mayo wrist score there were 8 excellent, 6 good, 1 fair, and 1 poor result. Partial SL ligament tears can be a source of radial-sided wrist pain. Scapholunate ligament debridement and thermal shrinkage effectively provided pain relief for most of the patients treated. Stability was maintained radiographically. No complications were noted from the use of radiofrequency probes. These reasonably favorable short-term results should be viewed cautiously. A longer follow-up study is necessary to determine the ultimate efficacy of this procedure.