Jenny E Dornberger1, Grit Rademacher2, Sven Mutze2, Andreas Eisenschenk3,4, Dirk Stengel5,6. 1. Department of Plastic Surgery and Burn Care, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Germany. jenny.dornberger@ukb.de. 2. Institute of Radiology, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Germany. 3. Department of Hand-, Replantation- and Microsurgery, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Germany. 4. Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany. 5. Centre for Clinical Research, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Germany. 6. Julius Wolff Institute, Centre for Musculoskeletal Surgery, Charité Medical University Centre, Berlin, Germany.
Abstract
OBJECTIVE: To determine the accuracy of common radiological indices for diagnosing ruptures of the scapholunate (SL) ligament, the most relevant soft tissue injury of the wrist. METHODS: This was a prospective diagnostic accuracy study with independent verification of index test findings by a reference standard (wrist arthroscopy). Bilateral digital radiographs in posteroanterior (pa), lateral and Stecher's projection were evaluated by two independent expert readers. Diagnostic accuracy of radiological signs was expressed as sensitivity, specificity, positive (PPV) and negative (NPV) predictive values with 95 % confidence intervals (CI). RESULTS: The prevalence of significant acute SL tears (grade ≥ III according to Geissler's classification) was 27/72 (38 %, 95 % CI 26-50 %). The SL distance on Stecher's projection proved the most accurate index to rule the presence of an SL rupture in and out. SL distance on plain pa radiographs, Stecher's projection and the radiolunate angle contributed independently to the final diagnostic model. These three simple indices explained 97 % of the diagnostic variance. CONCLUSIONS: In the era of computed tomography and magnetic resonance imaging, plain radiographs remain a highly sensitive and specific primary tool to triage patients with a suspected SL tear to further diagnostic work-up and surgical care. KEY POINTS: • Scapholunate ligament (SL) lesions are the most relevant soft tissue wrist injuries. • Missed and untreated SL ruptures can cause painful and disabling post-traumatic wrist osteoarthritis. • Reliable threshold values of radiographic indices should prompt further imaging or surgical care. • Plain radiographs deliver conclusive clinical information if certain hand positions are used.
OBJECTIVE: To determine the accuracy of common radiological indices for diagnosing ruptures of the scapholunate (SL) ligament, the most relevant soft tissue injury of the wrist. METHODS: This was a prospective diagnostic accuracy study with independent verification of index test findings by a reference standard (wrist arthroscopy). Bilateral digital radiographs in posteroanterior (pa), lateral and Stecher's projection were evaluated by two independent expert readers. Diagnostic accuracy of radiological signs was expressed as sensitivity, specificity, positive (PPV) and negative (NPV) predictive values with 95 % confidence intervals (CI). RESULTS: The prevalence of significant acute SL tears (grade ≥ III according to Geissler's classification) was 27/72 (38 %, 95 % CI 26-50 %). The SL distance on Stecher's projection proved the most accurate index to rule the presence of an SL rupture in and out. SL distance on plain pa radiographs, Stecher's projection and the radiolunate angle contributed independently to the final diagnostic model. These three simple indices explained 97 % of the diagnostic variance. CONCLUSIONS: In the era of computed tomography and magnetic resonance imaging, plain radiographs remain a highly sensitive and specific primary tool to triage patients with a suspected SL tear to further diagnostic work-up and surgical care. KEY POINTS: • Scapholunate ligament (SL) lesions are the most relevant soft tissue wrist injuries. • Missed and untreated SL ruptures can cause painful and disabling post-traumatic wrist osteoarthritis. • Reliable threshold values of radiographic indices should prompt further imaging or surgical care. • Plain radiographs deliver conclusive clinical information if certain hand positions are used.
Authors: Steve K Lee; Joseph Park; Michael Baskies; Rachel Forman; Gokce Yildirim; Peter Walker Journal: J Hand Surg Am Date: 2010-01-08 Impact factor: 2.230
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Authors: Tobias Johannes Dietrich; Andoni Paul Toms; Luis Cerezal; Patrick Omoumi; Robert Downey Boutin; Jan Fritz; Rainer Schmitt; Maryam Shahabpour; Fabio Becce; Anne Cotten; Alain Blum; Marco Zanetti; Eva Llopis; Maciej Bień; Radhesh Krishna Lalam; P Diana Afonso; Vasco V Mascarenhas; Reto Sutter; James Teh; Grzegorz Pracoń; Milko C de Jonge; Jean-Luc Drapé; Marc Mespreuve; Alberto Bazzocchi; Guillaume Bierry; Danoob Dalili; Marc Garcia-Elias; Andrea Atzei; Gregory Ian Bain; Christophe L Mathoulin; Francisco Del Piñal; Luc Van Overstraeten; Robert M Szabo; Emmanuel J Camus; Riccardo Luchetti; Adrian Julian Chojnowski; Jörg G Grünert; Piotr Czarnecki; Fernando Corella; Ladislav Nagy; Michiro Yamamoto; Igor O Golubev; Jörg van Schoonhoven; Florian Goehtz; Maciej Klich; Iwona Sudoł-Szopińska Journal: Eur Radiol Date: 2021-06-08 Impact factor: 5.315