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Imaging Assessment of Scaphoid Dorsal Translation in Patients with Scapholunate Instability
Jordan Carolina Villa, MD1; Eliana Saltzman, BA2; Jelle van Der List, MD1; Scott W. Wolfe, MD1; Steve K Lee, MD1
1Hospital for Special Surgery, New York, NY, 2Icahn School of Medicine at Mount Sinai, New York, NY
Introduction: Scapholunate instability is the most frequent posttraumatic dissociative carpal instability. Since initial diagnosis and classification is made based on radiographic findings, it is important to recognize abnormal scaphoid and lunate postures before progression to advanced stages. The purpose of this study was to radiographically assess scaphoid dorsal translation in patients with different stages of scapholunate instability and to correlate those findings with magnetic resonance imaging (MRI) measurements.
Methods: This study included a total of 65 patients divided in 3 groups: 21 patients had diagnoses of scapholunate ligament (SLIL) injury, 24 patients had scapholunate advanced collapse (SLAC) and 20 were control patients. Scaphoradial, scapholunate, radiolunate, capitolunate, scapholunate gap and scaphoid dorsal translation indices were assessed twice by three examiners. Scaphoid dorsal translation was defined as the distance (mm) between the centers of the best fit circles for (1) the scaphoid proximal articular surface and (2) the scaphoid fossa, using the external palmar cortex of the radius as the orientation axis. Interobserver reliabilities were determined and expressed as intraclass correlation coefficient (ICC). Convergent validity test, was used to assess the correlation between dorsal translation in radiographs and dorsal translation in MRI. Independent sample T- test was used to compare the alignment indices between the 3 groups.
Results: when comparing groups significant differences were found in the following radiographic measurements: scapholunate angle (p= 0.001), radiolunate angle (p=0.001), capitolunate angle (p=0.001) and scaphoid dorsal translation (mm) (p=0.001). No difference was found between groups for scaphoradial angle measurement (p=0.30). Intraclass correlation for measurements by reader 1, reader 2 and reader 3 using plain radiographs was 0.746, 0.720 and 0.910, respectively, and using MRI was 0.877, 0.906 and 0.895, respectively. The correlation between scaphoid dorsal translation in radiographs and MRI was moderate for reader 1 with ICCs 0.649 (95% CI -0.384-0.799) and strong for reader 2 and 3 with ICCs 0.702 and 0.764 respectively [95% CI (0.57-0.86) and (0.50-0.84) respectively].
Discussion and Conclusion: This study introduces a new radiographic parameter, scaphoid dorsal translation, in patients with diagnoses of scapholunate instability. This parameter could be correlated with the stage of instability since it showed significant difference between control, patients with SLIL injury and patients with SLAC. Radiographic scaphoid dorsal translation is correlated with MRI findings and might represent a lower cost option for early detection of the radioscaphoid joint eccentric wear seen in some stages of scapholunate instability.
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