This prospective observational study assessed the prevalence and one-year outcome of untreated ligament injuries associated with displaced distal radius fractures. Fifty-one consecutive patients that were taken to the operating room for treatment of a displaced distal radius fracture also underwent wrist arthroscopy. Ten patients were identified with a Geissler grade-3 scapholunate ligament injury named Group 1 and the remaining 41 patients with grade-0, 1, or 2 injuries were considered Group 2. Patients with >2mm of ulnar positive variance at the
time of injury had a fourfold increase in the risk of sustaining a grade-3 scapholunate tear and intra-articular fractures had a twofold increased risk. Self-reported measures of pain were not significantly different between groups nor were any objective measures of range of motion, grip or pinch strength. There was a greater incidence of pain with a Watson’s shift test in group 1 and a greater incidence of radiographic evidence of scapholunate widening at one year. Lunotriquetral injuries were rare in this study (3/51) and there were no statistical difference in TFCC tears between groups.
This study highlights the potential for an associated scapholunate ligament injury with a distal radius fracture that has significant ulnar positive variance or is intra-articular. Despite these findings, there was no subjective or objective difference at one year between the groups despite lack of treatment for these ligament injuries. The authors question whether these ligament injuries will be more symptomatic over time or due to earlier mobilization following open reduction with locking plates.
Distal, Radius, Fractures, Carpal, Ligament, Tears
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