Accuracy of simple plain radiographic signs and measures to diagnose acute scapholunate ligament injuries of the wrist (original) (raw)

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.

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Abbreviations

ACCORDS:

ACcuracy of COmmon Radiological tests for Diagnosing SL ligament ruptures

AUC/ROC:

area under the receiving operating characteristics curve

CI:

confidence interval

NPV:

negative predicted value

pa:

posteroanterior

PACS:

Picture Archiving and Communication System

PPV:

positive predicted value

RL:

radiolunate

SD:

standard deviation

SL:

scapholunate

STARD:

Standards for Reporting of Diagnostic Accuracy

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Acknowledgments

This study was supported by the German Osteoarthritis Aid ("Deutsche Arthrose-Hilfe e.V."), a non-profit foundation which supports clinical research on the diagnosis, prevention and treatment of osteoarthritis.

The scientific guarantor of this publication is Dirk Stengel, MD, PhD, MSc (Epi). The authors of this manuscript declare relationships with the following companies: Dr. Dornberger reports non-financial support from German Osteoarthritis Aid (Deutsche Arthrose-Hilfe e.V), during the conduct of the study.

Dr. Rademacher reports non-financial support from German Osteoarthritis Aid (Deutsche Arthrose Hilfe), during the conduct of the study. Prof. Mutze has nothing to disclose. Prof. Eisenschenk reports non-financial support from German Osteoarthritis Aid (Deutsche Arthrose Hilfe), during the conduct of the study. Dr. Stengel received honoraria, research grants and travel support by multiple sponsors and funding bodies (e.g. AO Trauma, Stryker, DePuy, Biomet, Aesculap). None related to this piece of research. This study received funding from the German Osteoarthritis Aid ("Deutsche Arthrose-Hilfe e.V."), a non-profit foundation which supports clinical research on the diagnosis, prevention and treatment of osteoarthritis. One of the authors has significant statistical expertise: Dirk Stengel, MD, PhD, MSc (Epidemiology), senior clinical epidemiologist and senior author of this manuscript. Institutional review board approval was obtained from the Charité University Medical Centre, Berlin, Germany (EA1/210/07). Written informed consent was obtained from all patients in this study. Study subjects or cohorts have not been previously reported. Methodology: prospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Plastic Surgery and Burn Care, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Germany
    Jenny E. Dornberger
  2. Institute of Radiology, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Germany
    Grit Rademacher & Sven Mutze
  3. Department of Hand-, Replantation- and Microsurgery, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Germany
    Andreas Eisenschenk
  4. Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
    Andreas Eisenschenk
  5. Centre for Clinical Research, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Germany
    Dirk Stengel
  6. Julius Wolff Institute, Centre for Musculoskeletal Surgery, Charité Medical University Centre, Berlin, Germany
    Dirk Stengel

Authors

  1. Jenny E. Dornberger
  2. Grit Rademacher
  3. Sven Mutze
  4. Andreas Eisenschenk
  5. Dirk Stengel

Corresponding author

Correspondence toJenny E. Dornberger.

Additional information

Jenny E. Dornberger, Grit Rademacher, Andreas Eisenschenk and Dirk Stengel contributed equally to this work.

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Dornberger, J.E., Rademacher, G., Mutze, S. et al. Accuracy of simple plain radiographic signs and measures to diagnose acute scapholunate ligament injuries of the wrist.Eur Radiol 25, 3488–3498 (2015). https://doi.org/10.1007/s00330-015-3776-2

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