Carpal Injuries Associated With Distal Radius Fractures: Arthroscopic-Tomographic Correlation
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Published:
Feb 24, 2025
Keywords:
Distal radius fracture, computed tomography, arthroscopy, associated injuries, intercarpal ligament
Main Article Content
Abstract
Introduction: Distal radius fractures are among the most common fractures. Associated intercarpal injuries have been reported in up to 70% of cases. If undiagnosed or untreated, these injuries can negatively impact functional outcomes. The aim of this study was to establish a correlation between computed tomography (CT) and arthroscopy in diagnosing intercarpal injuries associated with distal radius fractures.
Materials and Methods: We retrospectively analyzed 146 patients (aged 18–65 years) with distal radius fractures who underwent arthroscopically assisted surgery. Preoperative radiographs and CT scans of the wrist were evaluated. Triangular fibrocartilage complex (TFCC) injuries, ligament and osteochondral injuries, and carpal bone fractures were assessed based on pre-established imaging criteria, with arthroscopy serving as the diagnostic gold standard. The diagnostic accuracy of CT for these injuries was determined.
Results: For TFCC injuries, CT demonstrated a sensitivity of 84%, specificity of 65%, positive predictive value (PPV) of 77%, and negative predictive value (NPV) of 10%. For scapholunate ligament injuries, sensitivity was 61%, specificity 62%, PPV 60%, and NPV 63%. For osteochondral injuries, sensitivity was 55%, specificity 87%,PPV 22%, and NPV 97%.
Conclusion: There was no statistically significant correlation between CT and arthroscopy for the preoperative diagnosis of intercarpal injuries associated with distal radius fractures.
Materials and Methods: We retrospectively analyzed 146 patients (aged 18–65 years) with distal radius fractures who underwent arthroscopically assisted surgery. Preoperative radiographs and CT scans of the wrist were evaluated. Triangular fibrocartilage complex (TFCC) injuries, ligament and osteochondral injuries, and carpal bone fractures were assessed based on pre-established imaging criteria, with arthroscopy serving as the diagnostic gold standard. The diagnostic accuracy of CT for these injuries was determined.
Results: For TFCC injuries, CT demonstrated a sensitivity of 84%, specificity of 65%, positive predictive value (PPV) of 77%, and negative predictive value (NPV) of 10%. For scapholunate ligament injuries, sensitivity was 61%, specificity 62%, PPV 60%, and NPV 63%. For osteochondral injuries, sensitivity was 55%, specificity 87%,PPV 22%, and NPV 97%.
Conclusion: There was no statistically significant correlation between CT and arthroscopy for the preoperative diagnosis of intercarpal injuries associated with distal radius fractures.
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How to Cite
Laboranti, A., Lazzari, M., Pérez Lloveras, G. O., Casen Infante, F. G., Rognoni, T. M., Posse, R. A., Otero Consoli, M., Colombato, F., Casserá , F., & Caloia, M. (2025). Carpal Injuries Associated With Distal Radius Fractures: Arthroscopic-Tomographic Correlation. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(1), 34-42. https://doi.org/10.15417/issn.1852-7434.2025.90.1.1939
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Clinical Research
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References
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9. Suzuki D, Ono H, Furuta K, Katayama T, Akahane M, Omokawa S, et al. Comparison of scapholunate distance
measurements on plain radiography and computed tomography for the diagnosis scapholunate instability associated with distal radius fracture. J Orthop Sci 2014;19:465-70. https://doi.org/10.1007/s00776-014-0533-3
10. Tang JB. Re: Levels of experience of surgeons in clinical studies. J Hand Surg Eur Vol 2009;34(1):137-8.
https://doi.org/10.1177/17531934097321
11. Özkan S, Mudgal CS, Jupiter JB, Bloemers FW, Chen NC. Scapholunate diastasis in distal radius fractures: Fracture pattern análisis on CT scans. J Wrist Surg 2020;9(04):338-44. https://doi.org/10.1055/s-0040-1712505
12. Orbay JL, Badia A, Indriago IR, Infante A, Khouri RK, Gonzalez E, et al. The extended flexor carpi radialis approach: A new perspective for the distal radius fracture. Tech Hand Up Extrem Surg 2001;5(4):204-11.
https://doi.org/10.1097/00130911-200112000-00004
13. Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996;78(3):357-65.
https://doi.org/10.2106/00004623-199603000-00006
14. Palmer AK. Triangular fibrocartilage complex lesions: A classification. J Hand Surg 1989;14(4):594-606.
https://doi.org/10.1016/0363-5023(89)90174-3
15. Atzei A, Rizzo A, Luchetti R, Fairplay T. Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesión with distal radioulnar joint instability. Tech Hand Up Extrem Surg 2008;12(4):226-35.
https://doi.org/10.1097/BTH.0b013e3181901b1
16. Vigler M, Aviles A, Lee SK. Carpal fractures excluding the scaphoid. Hand Clin 2006;22(4):501-16.
https://doi.org/10.1016/j.hcl.2006.07.007
17. Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. J Bone Joint Surg Am 1972;
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18. Lindau T, Arner M, Hagberg L. Intraarticular lesions in distal fractures of the radius in young adults. J Hand Surg 1997;22(5):638-43. https://doi.org/10.1016/s0266-7681(97)80364-6
19. Abe Y, Tsubone T, Tominaga Y. Plate presetting arthroscopic reduction technique for the distal radius fractures. Tech Hand Up Extrem Surg 2008;12(3):136-43. https://doi.org/10.1097/BTH.0b013e3181670fe3
20. Richards RS, Bennett JD, Roth JH, Milne K. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg 1997;22(5):772-6. https://doi.org/10.1016/S0363-5023(97)80068-8
21. Ogawa T, Tanaka T, Yanai T, Kumagai H, Ochiai N. Analysis of soft tissue injuries associated with distal radius
fractures. Sports Med Arthrosc Rehabil Ther Amp Technol 2013;5(1). https://doi.org/10.1186/2052-1847-5-19
22. De Santis S, Cozzolino R, Luchetti R, Cazzoletti L. Comparison between MRI and arthroscopy of the wrist for the assessment of posttraumatic lesions of intrinsic ligaments and the triangular fibrocartilage complex. J Wrist Surg 2022;11(01):28-34. https://doi.org/10.1055/s-0041-1729757
23. Heo YM, Kim SB, Yi JW, Lee JB, Park CY, Yoon JY, et al. Evaluation of associated carpal bone fractures in distal
radial fractures. Clin Orthop Surg 2013;5(2):98-104. https://doi.org/10.4055/cios.2013.5.2.98
24. Trumble TE, Benirschke SK, Vedder NB. Ipsilateral fractures of the scaphoid and radius. J Hand Surg 1993;18(1):8-14. https://doi.org/10.1016/0363-5023(93)90237-W
25. Rutgers M, Mudgal CS, Shin R. Combined fractures of the distal radius and scaphoid. J Hand Surg Eur Vol
2008;33(4):478-83. https://doi.org/10.1177/1753193408090099
https://doi.org/10.1016/j.hcl.2012.02.001
2. Melton III LJ, Amadio PC, Crowson CS, O’Fallon WM. Long-term trends in the incidence of distal forearm fractures. Osteoporos Int 1998;8(4):341-8. https://doi.org/10.1007/s001980050073
3. Kelsey JL, Praemer A, Nelson LM, Felberg A, Rice DP. Upper extremity disorders: Frequency, impact and cost.
New York: Churchill Livingstone; 1997.
4. Lee Y-K, Kwon T-Y, Lee H-S. Arthroscopic treatment of chronic wrist pain after distal radius fractures. Medicine
(Baltimore) 2020;99(38):e22196. https://doi.org/10.1097/MD.0000000000022196
5. Cheng HS, Hung LK, Ho PC, Wong J. An analysis of causes and treatment outcome of chronic wrist pain after
distal radial fractures. Hand Surg 2008;13(01):1-10. https://doi.org/10.1142/S0218810408003748
6. Kwon BC, Baek GH. Fluoroscopic diagnosis of scapholunate interosseous ligament injuries in distal radius
fractures. Clin Orthop Relat Res 2008;466(4):969-76. https://doi.org/10.1007/s11999-008-0126-6
7. Desai MJ, Kamal RN, Richard MJ. Management of intercarpal ligament injuries associated with distal radius
fractures. Hand Clin 2015;31(3):409-16. https://doi.org/10.1016/j.hcl.2015.04.009
8. Gradl G, Neuhaus V, Fuchsberger T, Guitton TG, Prommersberger KJ, Ring D. Radiographic diagnosis of
scapholunate dissociation among intra-articular fractures of the distal radius: Interobserver reliability. J Hand Surg 2013;38(9):1685-90. https://doi.org/10.1016/j.jhsa.2013.05.039
9. Suzuki D, Ono H, Furuta K, Katayama T, Akahane M, Omokawa S, et al. Comparison of scapholunate distance
measurements on plain radiography and computed tomography for the diagnosis scapholunate instability associated with distal radius fracture. J Orthop Sci 2014;19:465-70. https://doi.org/10.1007/s00776-014-0533-3
10. Tang JB. Re: Levels of experience of surgeons in clinical studies. J Hand Surg Eur Vol 2009;34(1):137-8.
https://doi.org/10.1177/17531934097321
11. Özkan S, Mudgal CS, Jupiter JB, Bloemers FW, Chen NC. Scapholunate diastasis in distal radius fractures: Fracture pattern análisis on CT scans. J Wrist Surg 2020;9(04):338-44. https://doi.org/10.1055/s-0040-1712505
12. Orbay JL, Badia A, Indriago IR, Infante A, Khouri RK, Gonzalez E, et al. The extended flexor carpi radialis approach: A new perspective for the distal radius fracture. Tech Hand Up Extrem Surg 2001;5(4):204-11.
https://doi.org/10.1097/00130911-200112000-00004
13. Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996;78(3):357-65.
https://doi.org/10.2106/00004623-199603000-00006
14. Palmer AK. Triangular fibrocartilage complex lesions: A classification. J Hand Surg 1989;14(4):594-606.
https://doi.org/10.1016/0363-5023(89)90174-3
15. Atzei A, Rizzo A, Luchetti R, Fairplay T. Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesión with distal radioulnar joint instability. Tech Hand Up Extrem Surg 2008;12(4):226-35.
https://doi.org/10.1097/BTH.0b013e3181901b1
16. Vigler M, Aviles A, Lee SK. Carpal fractures excluding the scaphoid. Hand Clin 2006;22(4):501-16.
https://doi.org/10.1016/j.hcl.2006.07.007
17. Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. J Bone Joint Surg Am 1972;
54(8):1612-32. PMID: 4653642
18. Lindau T, Arner M, Hagberg L. Intraarticular lesions in distal fractures of the radius in young adults. J Hand Surg 1997;22(5):638-43. https://doi.org/10.1016/s0266-7681(97)80364-6
19. Abe Y, Tsubone T, Tominaga Y. Plate presetting arthroscopic reduction technique for the distal radius fractures. Tech Hand Up Extrem Surg 2008;12(3):136-43. https://doi.org/10.1097/BTH.0b013e3181670fe3
20. Richards RS, Bennett JD, Roth JH, Milne K. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg 1997;22(5):772-6. https://doi.org/10.1016/S0363-5023(97)80068-8
21. Ogawa T, Tanaka T, Yanai T, Kumagai H, Ochiai N. Analysis of soft tissue injuries associated with distal radius
fractures. Sports Med Arthrosc Rehabil Ther Amp Technol 2013;5(1). https://doi.org/10.1186/2052-1847-5-19
22. De Santis S, Cozzolino R, Luchetti R, Cazzoletti L. Comparison between MRI and arthroscopy of the wrist for the assessment of posttraumatic lesions of intrinsic ligaments and the triangular fibrocartilage complex. J Wrist Surg 2022;11(01):28-34. https://doi.org/10.1055/s-0041-1729757
23. Heo YM, Kim SB, Yi JW, Lee JB, Park CY, Yoon JY, et al. Evaluation of associated carpal bone fractures in distal
radial fractures. Clin Orthop Surg 2013;5(2):98-104. https://doi.org/10.4055/cios.2013.5.2.98
24. Trumble TE, Benirschke SK, Vedder NB. Ipsilateral fractures of the scaphoid and radius. J Hand Surg 1993;18(1):8-14. https://doi.org/10.1016/0363-5023(93)90237-W
25. Rutgers M, Mudgal CS, Shin R. Combined fractures of the distal radius and scaphoid. J Hand Surg Eur Vol
2008;33(4):478-83. https://doi.org/10.1177/1753193408090099