Skip to main content
SpringerLink
Log in

The role of MDCT arthrography in the follow-up of scapholunate stabilisation

Ruolo dell’artrografia-TC nel follow-up della stabilizzazione scafo-lunata

  • Musculoskeletal Radiology / Radiologia Muscolo-Scheletrica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to assess outcomes in a group of patients with scapholunate dissociation treated with stabilisation surgery (Brunelli-Stanley) and to compare arthrography with multidetector computed tomography (MDCT) with conventional radiography, the gold standard in the follow-up of wrist surgery.

Materials and methods

Twelve patients (13 wrists) underwent surgery for scapholunate dissociation and were followed up with clinical (visual analogue scale, Mayo Wrist Score, Patient-Rated Wrist Evaluation, and Disabilities of the Arm, Shoulder, and Hand) and radiological assessment (conventional radiography and CT arthrography). Conventional radiography was assessed for: the scapholunate gap, scapholunate angle, radiolunate angle, capitate-lunate angle, and carpal height index; the CT arthrography images were also evaluated for: the distance between the dorsal exit hole of the bone tunnel and the proximal scaphoid pole, the thickness and tension of the flexor carpi radialis (FCR) strip, and any signs of joint degeneration.

Results

Analysis of the data from conventional radiography and MDCT arthrography demonstrated a significant statistical correlation among the measurements obtained on the radiograms and multiplanar CT reconstructions and the patients’ clinical outcome.

Conclusions

Our results show that MDCT arthrography has the same value as conventional radiography in the evaluation of standard parameters (scapholunate gap, scapholunate angle, radiolunate angle, capitolunate angle, carpal height index), but in addition provides an accurate delineation of the FCR tendon graft, allowing differentiation of its thickness, direction and degree of tension.

Riassunto

Obiettivo

Scopo del presente lavoro è valutare l’outcome di un gruppo di pazienti affetti da dissociazione scafolunata (DSL) sottoposti a intervento chirurgico di stabilizzazione (Brunelli-Stanley) e descrivere il ruolo dell’artrografia-TC (artro-TC) confrontandola con la radiografia, gold standard nel follow-up del polso operato.

Materiali e metodi

Dodici pazienti (13 polsi) operati per stabilizzazione in DSL; follow-up a 47,2 mesi mediante valutazione clinica (Visual Analogue Scale — VAS, Mayo Wrist Score, Patient-Rated Wrist Evaluation — PRWE e Disabilities of the Arm, Shoulder and Hand scale — DASH) e radiologica (Rx e artro-TC). I criteri radiografici analizzati sono stati: l’intervallo scafo-lunato, l’angolo scafo-lunato, l’angolo radio-lunato, l’angolo capitolunato e l’indice di altezza del carpo. L’artro-TC ha inoltre valutato la distanza tra il foro di uscita dorsale del tunnel osseo e il polo prossimale dello scafoide, lo spessore, l’integrità e il grado di tensione del neolegamento e i segni di degenerazione articolare.

Risultati

L’analisi dei reperti radiografici e dell’artro-TC hanno dimostrato una correlazione statisticamente significativa tra le misurazioni prese sulla radiografia convenzionale e sulle ricostruzioni multiplanari (MPR) e l’outcome clinico dei pazienti.

Conclusioni

I nostri risultati mostrano che l’artro-TC ha lo stesso valore della radiografia nella valutazione dei parametri standard (intervallo scafo-lunato, angolo scafolunato, angolo capitato lunato, angolo radio-lunato, indice di altezza carpale) e consente inoltre l’identificazione del neolegamento permettendo la differenziazione di spessore, direzione e grado di tensione.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References/Bibliografia

  1. Kauer JM (1986) The mechanism of the carpal joint. Clin Orthop Relat Res 202:16–26. DOI: 10.1016/0266-7681(93)90015-8

    PubMed  Google Scholar 

  2. Garcia-Elias M (1999) Definition of carpal instability. The Anatomy and Biomechanics Committee of the International Federation of Societes for Surgery of the Hand. J Hand Surg Am 24:866–867. DOI: 10.1053/ jhsu.1999.0866

    Article  Google Scholar 

  3. Yin Y, Mann FA, Hodge JC, Gilula LA (1996) Roentgenographic interpretation of ligamentous instabilities of the wrist. Static and dynamic instabilities. In: Gilula LA, Yin Y (eds) Imaging of the wrist and hand. Saunders, Philadelphia, pp 203–324

    Google Scholar 

  4. Schmitt R, Froehner S, Coblenz G, Christopoulos G (2006) Carpal instability. Eur Radiol 16:2161–2178. DOI: 10.1007/s00330-006-0161-1

    Article  PubMed  CAS  Google Scholar 

  5. Jones WA (1988) Beware the sprained wrist. The incidence and diagnosis of scapholunate instability. J Bone Joint Surg Br 70:293–297

    PubMed  CAS  Google Scholar 

  6. Taleisnik J (1988) Scapholunate ligament excision. J Hand Surg Am 13:790–792

    Article  PubMed  CAS  Google Scholar 

  7. Mayfield JK, Johnson RP, Kilcoyne RK (1980) Carpal dislocations: pathomechanics and progressive perilunate instability. J Hand Surg Am 5:226–241

    Article  PubMed  CAS  Google Scholar 

  8. Viegas SF, Patterson RM, Peterson PD et al (1990) Ulnar-sided perilunate instability: an anatomic and biomechanic study. J Hand Surg Am 15:268–278

    Article  PubMed  CAS  Google Scholar 

  9. Lichtman DM, Martin RA (1980) Introduction to the carpal instabilities. In: Lichtman DM (ed) The wrist and its disorders. Saunders, Philadelphia, pp 244–250

    Google Scholar 

  10. Resnick D, Niwayama G (1977) Carpal instability in rheumatoid arthritis and calcium pyrophosphate deposition disease. Ann Rheum Dis 36:311–318

    Article  PubMed  CAS  Google Scholar 

  11. Lavernia CJ, Cohen MS, Taleisnik J (1992) Treatment of scapholunate dissociation by ligamentous repair and capsulodesis. J Hand Surg Am 17:354–359. DOI: 10.1016/0363-5023(92)90419-P

    Article  PubMed  CAS  Google Scholar 

  12. Wollstein R, Watson HK, Wear-Maggitti K et al (2008) Surgical technique for the treatment of radial wrist pain. Scand J Plast Reconstr Surg Hand Surg 42:149–152. DOI: 10.1080/02844310801987685

    Article  PubMed  Google Scholar 

  13. Young Szalay MD, Peimer CA (2002) Scaphocapitate arthrodesis. Tech Hand Up Extrem Surg 6:56–60

    Article  PubMed  Google Scholar 

  14. Harvey EJ, Berger RA, Osterman AL et al (2007) Bone-tissue-bone repairs for scapholunate dissociation. J Hand Surg Am 32:256–264. DOI: 10.1016/j. jhsa.2006.11.011

    Article  PubMed  Google Scholar 

  15. Brunelli GA, Brunelli GR (1996) A new surgical technique for carpal instability with scapholunate dissociation. Surg Technol Int 5:370–374

    PubMed  CAS  Google Scholar 

  16. O’Meeghan CJ, Stuart W, Mamo V et al (2003) The natural history of an untreated isolated scapholunate interosseus ligament injury. J Hand Surg Br 28:307–310. DOI: 10.1016/S0266-7681(03)00079-2

    Article  PubMed  Google Scholar 

  17. Talwalkar SC, Edwards AT, Hayton MJ et al (2006) Results of tri-ligament tenodesis: a modified Brunelli procedure in the management of scapholunate instability. J Hand Surg Br 31:110–117. DOI: 10.1016/j. jhsb.2005.09.016

    Article  PubMed  CAS  Google Scholar 

  18. Van Den Abbeele KL, Loh YC, Stanley JK, Trail IA (1998) Early results of a modified Brunelli procedure for scapholunate instability. J Hand Surg Br 23:258–261

    Article  Google Scholar 

  19. Bleuler P, Shafighi M, Donati LF et al (2008) Dynamic repair of scapholunate dissociation with dorsal extensor carpi radialis lungus tenodesis. J Hand Surg Am 33:281–284. DOI: 10.1016/j. jhsa.2007.11.018

    Article  PubMed  Google Scholar 

  20. Moran SL, Ford KS, Wulf CA, Cooney WP (2006) Outcomes of dorsal capsulodesis and tenodesis for treatment of scapholunate instability. J Hand Surg Am 31:1438–1446. DOI: 10.1016/j.jhsa.2006.08.002

    Article  PubMed  Google Scholar 

  21. Howlett JP, Pfaelle HJ, Waitayawinyu T, Trumble TE (2008) Distal tunnel placement improves scaphoid flexion with the Brunelli tenodesis procedure for scapholunate dissociation. J Hand Surg Am 33:1756–1764. DOI: 10.1016/j.jhsa.2008.08.022

    Article  PubMed  Google Scholar 

  22. Moser T, Dosch JC, Moussaoui A et al (2008) Multidetector CT arthrography of the wrist joint: how to do it. Radiographics 28:787–800. DOI: 10.1148/rg.283075087

    Article  PubMed  Google Scholar 

  23. Toms AP, Chojnowski A, Cahir JG (2010) Midcarpal instability: a radiological perspective. Skeletal Radiol 40:533–541. DOI: 10.1007/ s00256-010-0941-1

    Article  PubMed  Google Scholar 

  24. Watson HK, Ashmead D 4th, Makhlouf MV (1988) Examination of the scaphoid. J Hand Surg Am 13:657–660

    Article  PubMed  CAS  Google Scholar 

  25. Amadio PC, Berquist TH, Smith DK et al (1989) Scaphoid malunion. J Hand Surg Am 14:679–687

    Article  PubMed  CAS  Google Scholar 

  26. MacDermid JC, Turgeon T, Richards RS et al (1998) Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 12:577–586

    Article  PubMed  CAS  Google Scholar 

  27. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind MeD 29:602–608

    Article  PubMed  CAS  Google Scholar 

  28. Schimmerl-Metz SM, Metz VM, Totterman SM et al (1999) Radiologic measurement of the scapholunate joint: implications of biologic variation in scapholunate joint morphology. J Hand Surg Am 24:1237–1244. DOI: 10.1053/ jhsu.1999.1237

    Article  PubMed  CAS  Google Scholar 

  29. Wright TW, Del Charco M, Wheeler D (1994) Incidence of ligament lesions and associated degenerative changes in the elderly wrist. J Hand Surg Am 19:313–318

    Article  PubMed  CAS  Google Scholar 

  30. Garcia-Elias M, Vall A, Salo JM, Lluch AL (1988) Carpal alignment after different surgical approaches to the scaphoid: a comparative study. J Hand Surg Am 13:604–612

    Article  PubMed  CAS  Google Scholar 

  31. Drewniany JJ, Palmer AK, Flatt AE (1985) The scaphotrapezial ligament complex: an anatomic and biomechanical study. J Hand Surg Am 10:492–498

    Article  PubMed  CAS  Google Scholar 

  32. Palmer AK, Levinsohn EM, Kuzma GR (1983) Arthrography of the wrist. J Hand Surg Am 8:15–23

    Article  PubMed  CAS  Google Scholar 

  33. Schernberg F (1990) Roentgenographic examination of the wrist: a systematic study of the normal, lax and injured wrist. Part 1: The standard and positional views. J Hand Surg Br 15:210–219

    PubMed  CAS  Google Scholar 

  34. Oberladstätter J, Arora R, Dallapozza C et al (2009) Radiological radio-carpal and mid-carpal motion after operative treatment of dorsal radio-carpal fracture dislocations. Arch Orthop Trauma Surg 130:77–81. DOI: 10.1007/s00402-009-0902-0

    Article  Google Scholar 

  35. Moser T, Khoury V, Harris PG et al (2009) MDCT arthrography or MR arthrography for imaging the wrist joint? Semin Musculoskelet Radiol 13:39–54. DOI: 10.1055/s-0029-1202244

    Article  PubMed  Google Scholar 

  36. Lee MJ, Kim S, Lee SA et al (2007) Overcoming artifacts from metallic orthopedic implants at high-fieldstrength MR imaging and multidetector CT. Radiographics 27:791–803. DOI: 10.1148/rg.273065087

    Article  PubMed  Google Scholar 

  37. Theumann N, Favarger N, Schnyder P, Meuli R (2001) Wrist ligament injuries: value of post-arthrography computed tomography. Skeletal Radiol 30:88–93

    Article  PubMed  CAS  Google Scholar 

  38. Damet J, Sans-Merce M, Miéville F et al (2010) Comparison of organ doses and image quality between CT and flat panel XperCT scans in wrist and inner ear examinations. Radiat Prot Dosimetry 139:164–168. DOI: 10.1093/rpd/ncq062

    Article  PubMed  CAS  Google Scholar 

  39. Rogalla P, Kloeters C, Hein PA (2009) CT technology overview: 64-slice and beyond. Radiol Clin North Am 47:1–11. DOI: 10.1016/j.rcl.2008.10.004

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Università dell’Insubria, Via Guicciardini, 21100, Varese, Italy

    Eugenio Genovese, Emanuela Spanò, Davide Mariani, Irene De Bernardi & Carlo Fugazzola

  2. Department of Orthop and Trauma, Università dell’Insubria, Varese, Italy

    Giorgio Pilato

Authors
  1. Eugenio Genovese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emanuela Spanò
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Davide Mariani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Irene De Bernardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giorgio Pilato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carlo Fugazzola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eugenio Genovese.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Genovese, E., Spanò, E., Mariani, D. et al. The role of MDCT arthrography in the follow-up of scapholunate stabilisation. Radiol med 118, 1157–1170 (2013). https://doi.org/10.1007/s11547-013-0949-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-013-0949-4

Keywords

Parole chiave

Search

Navigation