Periscaphoid Injuries - Heath Taylor 20/3/2001

Injuries Associated with Scaphoid Fractures

SLAC Stage I - radial styloid v waist of scaphoid

Stage II - radioscaphoid joint

Stage III - capitolunate joint

DISI & VISI The SL ligament is dorsal, and keeps the lunate in a flexed position. The ST ligament is volar, and keeps the lunate extended. Therefore, if you rupture the SL ligament, the lunate tends to extend, and therefore DISI results, and vice versa.

Authors

Mayfield

Title

Mechanism of Carpal Injuries

Reference

Clin Orthop. 1980 Jun;(149):45-54

Summary

The first major review article acknowledges many previous theories. Defines the role of each of the radiocarpal & intercarpal ligaments. Cadaveric Study of 32 wrists were loaded to failure, either fast or slow. Cine XRs were taken, and post-failure dissection carried out. Results all specimens had disruption of RSL & SLL. 13 had dorsal perilunate dislocations. Lunate ligament injury is sequential and can be graded. Same tests done to assess scaphoid fractures in 29 wrists. Most demonstrated Perilunar instability or radial styloid, or other carpal bone fractures. Failure occurred on the palmar and radial side first (either # or sc-lun diss.)

Critique

Cadaveric study.

Take Home Message

Carpal fractures and ligamentous injuries are part of a continuum of injury. Usually is extension, ulna deviation and intercarpal supination as a mechanism



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