Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Pyeongchon-dong Dongan-gu, Anyang-si Gyeonggi-do, 431-070, South Korea.
J Bone Joint Surg Am. 2011 May 4;93(9):855-62. doi: 10.2106/JBJS.J.00361.
Intra-articular distal radial fractures are frequently accompanied by a scapholunate interosseous ligament injury, which may adversely affect the outcomes. Arthroscopy may not be appropriate as a first-line evaluation method to diagnose these injuries because of time, expense, and availability issues. The purpose of this study was to evaluate the effectiveness of the modified carpal stretch test for screening for scapholunate interosseous ligament injuries in patients with an intra-articular distal radial fracture.
The carpal stretch test is a radiographic evaluation in which disruption of the smooth arc of the proximal carpal row joint line indicates a lack of integrity of the scapholunate interosseous ligament. We modified the original carpal stretch test and prospectively performed the modified test on forty-eight patients with a total of forty-nine unstable intra-articular distal radial fractures. With the patient under anesthesia, the injured wrist was evaluated with the modified carpal stretch test with fluoroscopy. The wrist was then examined arthroscopically to classify the scapholunate interosseous ligament injury. Three observers independently determined whether there was disruption of the proximal carpal row joint line (Gilula's arc II), used as an indicator of a grade-III or IV scapholunate interosseous ligament tear, on fluoroscopic images. The fluoroscopic results were compared with the arthroscopic findings.
The average sensitivity of the modified carpal stretch test was 78%, the average specificity was 72%, the average positive predictive value was 60%, the average negative predictive value was 87%, and the average accuracy was 74%. The intraclass correlation coefficient (ICC) for interobserver agreement was 0.73, and the ICCs for intraobserver agreement were 0.86, 0.68, and 0.84 for the three observers.
The modified carpal stretch test was useful to rule out grade-III or IV scapholunate interosseous ligament tears associated with intra-articular distal radial fractures, but it was not as useful to confirm the presence of a tear. This test may reduce the necessity for arthroscopic assessment to identify scapholunate interosseous ligament injuries following distal radial fractures and may improve the rates of detection of important carpal ligament injuries accompanying intra-articular distal radial fractures.
关节内桡骨远端骨折常伴有舟月骨间韧带损伤，这可能会对预后产生不利影响。由于时间、费用和可用性等问题，关节镜检查可能不是诊断这些损伤的首选评估方法。本研究旨在评估改良腕骨拉伸试验在筛查关节内桡骨远端骨折患者舟月骨间韧带损伤中的有效性。
腕骨拉伸试验是一种影像学评估方法，其中近端腕骨列关节线的平滑弧形中断表明舟月骨间韧带完整性缺失。我们改良了原始的腕骨拉伸试验，对 48 例共 49 例不稳定关节内桡骨远端骨折患者进行了前瞻性改良试验。在麻醉下，用改良腕骨拉伸试验对受伤手腕进行透视评估。然后对腕关节进行关节镜检查，对舟月骨间韧带损伤进行分类。三名观察者独立确定透视图像上是否存在近端腕骨列关节线中断（吉尔拉弧 II），作为 III 级或 IV 级舟月骨间韧带撕裂的指标。将透视结果与关节镜检查结果进行比较。
改良腕骨拉伸试验的平均灵敏度为 78%，平均特异性为 72%，平均阳性预测值为 60%，平均阴性预测值为 87%，平均准确率为 74%。观察者间一致性的组内相关系数（ICC）为 0.73，三位观察者的组内一致性 ICC 分别为 0.86、0.68 和 0.84。
改良腕骨拉伸试验可用于排除与关节内桡骨远端骨折相关的 III 级或 IV 级舟月骨间韧带撕裂，但对确认撕裂的作用不大。该试验可能减少关节镜评估的必要性，以确定桡骨远端骨折后舟月骨间韧带损伤，并且可能提高伴随关节内桡骨远端骨折的重要腕骨韧带损伤的检出率。
