Arthroscopic management of scapholunate dissociation

Abstract

Radial styloid fractures may be relatively simple distal radial fractures or part of an incomplete or complete greater arch perilunate dislocation (Fig. 8.1a) [11]. If it is a part of a perilunate dislocation, all of us are aware about the need to assess and fully treat both the radial and ulnar-sided injuries. It is therefore surprising that we still struggle to identify associated injuries with all other distal radius fractures (Fig. 8.1a-d). These assumptions are supported by the fact that scapholunate (SL) disruptions are more common with displaced partial articular or intra-articular (AO B and C Types) than extra-articular fractures [6]. In fact, the prevalence of SL ligamentous injury in displaced distal radius fractures have been found to be as high as 85%, but also as low as 18% (Fig. 8.2) [9, 12, 16, 18]. The impact of intra-articular fracture distribution is further emphasized by the fact that late presenting symptomatic SL dissociations have been found in patients with arthroscopically-diagnosed grade 3 and 4 SL ligament tears at the time of the fracture (Table 8.1) [3]. Furthermore, there is a fourfold risk of such significant grade 3-4 SL tears with an ulnar variance of >2 mm on the initial radiographs [3]. © 2010 Springer-Verlag Berlin Heidelberg.