Incidence and functional outcome of inter-carpal ligament injuries associated with fractures of distal radius

• Published in: "Qazaqstannyn͡g︡ klinikalyq medit͡s︡inasy" zhurnaly Vol. 20; no. 6; pp. 55 - 59
• Main Authors: Nilesh Verma, BP Sharma, Sandeep Shaina, Abhishek Sengupta, Ashish Jaiman
• Format: Journal Article
• Language: English
• Published: National Scientific Medical Center 01-12-2023
• Subjects: distal radius fracture; Intercarpal ligament; scapho-lunate
• ISSN: 1812-2892; 2313-1519

Introduction: Although the prevalence of intercarpal ligament injuries with distal radius fractures ranges from 0.5 to 75 percent, these injuries are often missed by the untrained eye. Currently, wrist arthroscopy is considered gold standard for diagnosis and treatment, but in Indian setting it is an impractical proposition. Scapho-lunate and luno-triquetral injuries can be identified on X rays easily by Gilula’s arc, scapholunate distance and angle, carpal height ratio etc. The aim of this study is to estimate the prevalence of intercarpal ligament injuries in distal radius (DER) fractures and determine their functional outcome at one year. Material and methods: The study was conducted over 18 months at VMMC and Safdarjung Hospital. Patients with distal radius fractures were subjected to wrist X rays in 100% magnification and earlier mentioned parameters were measured. Patients who needed surgery were operated for fracture DER. Immediate post-operative X rays and X rays at 1 year were compared with that of the contralateral wrist. Patients’ clinical outcomes like range of motion, grip strength, quick DASH score and pain on VAS were measured at one year to assess the clinical outcome. Results: The study population was of 103 patients. Prevalence of intercarpal injuries in patients with DER fractures was 11.7%. Out of these 12 patients, 50% had broken Gilula’s arc, 66.6% had increased scapho-lunate distance and 42% had increased scapho-lunate angle. Carpal height ratio was significantly less in patients with intercarpal ligament injuries at one year. Similarly, functional outcome was worse in these patients at one year. Conclusion: Intercarpal injuries are associated with worse outcomes in patients with fracture DER. These injuries can reliably diagnosed on X rays using the parameters mentioned. Since the prevalence is quite high, we should learn to diagnose them early, so that patients can be explained about the prognosis of their injury.