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.
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Authors
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Mayfield
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Title
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Mechanism of Carpal Injuries
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Reference
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Clin Orthop. 1980 Jun;(149):45-54
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Summary
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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.)
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Critique
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Cadaveric study.
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Take Home Message
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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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