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Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography

  • Musculoskeletal
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Abstract

Objectives

To evaluate the prevalence of injuries of the scapholunate and lunotriquetral interosseous ligaments (SLIL, LTIL) as well as the triangular fibrocartilage complex (TFCC) in intra-articular distal radius fractures (iaDRF).

Methods

Two hundred and thirty-three patients with acute iaDRF underwent MDCT arthrography. The SLIL and LTIL were described as normal, partially or completely ruptured. Major injuries of the SLIL were defined as completely ruptured dorsal segments, those of the LTIL as completely ruptured palmar segments. The TFCC was judged as normal or injured. Interobserver variability was calculated. Injury findings were correlated with the types of iaDRF (AO classification).

Results

In 159 patients (68.2 %), no SLIL injuries were seen. Minor SLIL injuries were detected in 54 patients (23.2 %), major injuries in 20 patients (8.6 %). No correlation was found between the presence of SLIL lesions and the types of iaDRF. Minor LTIL injuries were seen in 23 patients (9.9 %), major injuries in only 5 patients (2.2 %). The TFCC was altered in 141 patients (60.5 %). Interobserver variability was high for MDCT arthrography in assessing SLIL and TFC lesions, and fair for LTIL lesions.

Conclusion

In iaDRF, prevalence of major injuries of the most relevant SLIL is about 9 % as evaluated with CT arthrography.

Key Points

• The C-shaped SLIL is built of dorsal, middle and palmar segments.

• In iaDRF, major SLIL injuries are associated in 8.6 % of the cases.

• In iaDRF, the SLIL remains intact in 68.3 % of the cases.

• IaDRF and SLIL ruptures can comprehensively be depicted with MDCT arthrography.

• A three-compartment approach is recommended to assess intrinsic ligaments and the TFCC.

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Abbreviations

iaDRF:

intra-articular Distal Radius Fracture

LTIL:

LunoTriquetral Interosseous Ligament

dSLIL:

dorsal segment of the ScaphoLunate Interosseous Ligament

mSLIL:

middle segment of the ScaphoLunate Interosseous Ligament

pSLIL:

palmar segment of the ScaphoLunate Interosseous Ligament

MDCT:

MultiDetector Computed Tomography

MPR:

MultiPlanar Reformation

OR:

Odds Ratio

p :

p-value

SLD:

ScaphoLunate Dissociation

SLIL:

ScaphoLunate Interosseous Ligament

TFC:

Triangular FibroCartilage (ulnocarpal disc)

TFCC:

Triangular FibroCartilage Complex

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Acknowledgements

The present work was performed in fulfillment of the requirements for obtaining the degree “Dr. med.” of the Friedrich-Alexander-University Erlangen-Nürnberg (FAU).

The scientific guarantor of this publication is Prof. Rainer Schmitt (Department of Diagnostic and Interventional Radiology, Cardiovascular Center, Salzburger Leite 1, 97616 Bad Neustadt an der Saale, Germany). The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Daniela Keller (Germany) kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Cardiovascular Center Bad Neustadt an der Saale, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Germany

    A. Klempka, M. Wagner, S. Fodor & R. Schmitt

  2. Clinic for Hand Surgery, Salzburger Leite 1, Bad Neustadt an der Saale, 97616, Germany

    K. J. Prommersberger

  3. Department of Diagnostic Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Maximiliansplatz 1, Erlangen, 91054, Germany

    M. Uder

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  1. A. Klempka
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Correspondence to A. Klempka.

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Klempka, A., Wagner, M., Fodor, S. et al. Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography. Eur Radiol 26, 722–732 (2016). https://doi.org/10.1007/s00330-015-3871-4

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