[Occult scaphoid-lunate dissociation in distal radius fractures].
BACKGROUND
The aim of this study was to investigate the clinical consequences of scapholunate dissociation associated with fractures of the distal radius and the impact on wrist function. Fractures of the distal radius and scapholunate dissociation overlap in pathomechanics. The diagnosis however is frequently missed initially.


METHODS
We reviewed 45 consecutive patients with closed distal radius fractures with a mean follow up of 48 months. Ten patients underwent surgery and 35 patients were treated by fracture reduction and cast immobilization during 4.5 (range 3 to 8) weeks. All patients were re-examined clinically and radiographs of both wrists were compared.


RESULTS
Four patients showed evidence of SLD in the scapholunate joint region based on specific criteria (scapholunate gaps > 2 mm on anterior-posterior radiograph and the scapholunate angle > 60 degrees on lateral radiograph). All patients with SLD showed a poor radioulnar deviation. Three patients reported mild to moderate pain.


CONCLUSIONS
The difficulties in management of SLD may be avoided by early detection and treatment. In all investigated patients the diagnosis was missed after the initial trauma. Untreated SLD can lead to carpal collapse and arthrosis of the wrist, and ultimately to scapholunate advanced collapse.
Schwendenwein
Elisabeth
E
Universitätsklinik für Unfallchirurgie, Wien, Osterreich. elisabeth.schwendenwein@akh-wien.ac.at
Wozasek
Gerald E
GE
Hajdu
Stefan
S
Vécsei
Vilmos
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology*; D012667:Lunate Bone / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011885:Radius Fractures / Q000150:complications* / Q000601:surgery / Q000628:therapy; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries*; D013997:Time Factors; D014954:Wrist Injuries / Q000000981:diagnostic imaging; D014955:Wrist Joint / Q000502:physiology