[Comparison of functional results with MRI findings after surgical treatment of transscaphoid perilunate fracture dislocations of the wrist: the role of scapholunate ligament lesions].
OBJECTIVE
The aim of this study was to review the outcome of transscaphoid perilunate fracture dislocations by MRI to use the advantages of MRI to show the post-traumatic degenerative changes, the examination of cartilage, the integrity of the ligaments and the vascularisation of the carpal bones. A second aim of this study is to interpret the findings in correlation to the functional results and the individual perception of hand functionality (PRWE).


METHODS
In this retrospective study, 20 patients (1 woman and 19 men), who were treated with open reduction and internal fixation at our institution, were reviewed at a mean of 67 (25-145) months postoperative. The mean age was 30 (12-73) years. The functional results were measured by range of motion (ROM), grip and pinch strength. The Mayo and Krimmer wrist scores were calculated and the SF-36 and the patient-rated wrist evaluation (PRWE) questionnaires were performed. Radiological findings included consolidation of the fracture and the radiological measures (revised carpal height, SL gap, SL and RL angle). An MRI, performed without a contrasting agent, was used to assess the degenerative changes of the joints, the vascularisation of the carpalia and the integrity of the SL ligament. Statistical data was calculated with SPSS.


RESULTS
Range of motion and strength were reduced by 10-20% compared to the uninjured opposite side. Although the majority of the patients (85%) achieved good to very good results in the Mayo and Krimmer wrist scores, the MRI showed osteoarthritis in 95% of the cases in at least in 1 out of 5 patients evaluated intracarpal joints. MRI showed signs of complete SL ligament tears in 5 patients and a partial tear in 2 patients. The same group also showed the strongest degenerative changes. However, there was no correlation between patient satisfaction and imaging results.


CONCLUSIONS
MRI findings, as well as X-ray findings, do not correlate with the subjective and objective functional outcomes after surgical treatment of transscaphoid perilunate fracture dislocations. It can be assumed that SL ligament lesions seen in MRI play a major role over the long term course.
Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich, Switzerland.
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Strobel
Orthopedic Clinic, Ars Medica Clinic, Gravesano-Lugano, Switzerland.
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I
Tami
Institut für Diagnostische und Interventionelle Radiologie, Universitätsspital Zürich, Zürich, Switzerland.
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Andreisek
Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich, Switzerland.
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Giovanoli
Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich, Switzerland.
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M
Calcagni
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000175:diagnosis* / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis* / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries* / Q000601:surgery*; D012667:Lunate Bone / Q000293:injuries* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000293:injuries* / Q000601:surgery; D055815:Young Adult