title: Radiographic assessment of ligamentous injuries in distal radius fractures after open reduction and internal fixation.
abstract: OBJECTIVE
  Concomitant ligamentous injury in distal radius fractures (DRF) may explain continued pain following surgery. The purpose of this study was to compare radiographic measurements assessing scaphoid translation in DRF after reduction, to measurements performed on normal radiographs. This may allow noninvasive evaluation of radiocarpal ligamentous integrity.
  
  
  METHODS
  Fifty postoperative radiographs were evaluated. The distance between the ulnar border of the radial styloid and the radial border of the scaphoid was measured midway between the styloid tip and scaphoid base, and then divided by scaphoid width at the same level. The measured ratios were compared to previously established normal data, established radiographic measurements of fracture reduction, fracture characteristics and fixation methods.
  
  
  RESULTS
  Radiographic scaphoid position measurements differed significantly from normals (p = 0.0001). Fracture characteristics, surgical difficulty, and technique were not associated with scaphoid position.
  
  
  CONCLUSIONS
  Despite accurate surgical reduction, abnormal positioning of the scaphoid may persist. This may reflect ligamentous injury, which generates suboptimal clinical results. Identifying and addressing ligamentous injury during surgery may prevent the development of instability and improve outcome after DRF.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Department of Orthopedic Surgery, University of Pittsburgh Medical Center, 3550 Terrace St., Pittsburgh, PA, 15261, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Naran
authors.forename: Yaron
authors.initials: Y
authors.lastname: Zaulan
authors.forename: Sameer
authors.initials: S
authors.lastname: Shakir
authors.forename: Louis A
authors.initials: LA
authors.lastname: Gilula
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Werner
authors.forename: Ronit
authors.initials: R
authors.lastname: Wollstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D057072:Intra-Articular Fractures / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging; D011885:Radius Fractures / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D012016:Reference Values; D021361:Scaphoid Bone / Q000000981:diagnostic imaging*; D014457:Ulna / Q000000981:diagnostic imaging; D014954:Wrist Injuries / Q000000981:diagnostic imaging*; D055815:Young Adult