Can cast immobilization successfully treat scapholunate dissociation associated with distal radius fractures?
During a 3.5-year period, 20 of 424 consecutive patients with fractures of the distal radius presented with evidence of scapholunate dissociation upon x-ray films and traction view fluoroscopy. The sequential changes of x-ray abnormalities of the scapholunate joint were consistently observed over a 1-year period, and wrist functions were evaluated 1 year after injury. The scapholunate gaps were 3.5 +/- 0.5 mm at the time of injury, 3.2 +/- 0.4 mm immediately after closed reduction of the fracture, 3.4 +/- 0.5 mm at the time after removal of fixation, and 3.8 +/- 0.4 mm 1 year after injury. By the modified clinical scoring system of Green and O’Brien, of these 20 patients, none had excellent, 2 had good, 14 had fair, and 4 had poor wrist function 1 year after injury. The wrists with scapholunate dissociation had significantly worse function as compared to a selected subgroup of 228 wrists with no signs of intercarpal ligament disruption. All 20 patients with signs of scapholunate dissoc
