Incidence and functional outcome of inter-carpal ligament injuries associated with fractures of distal radius

Nilesh Verma 1, BP Sharma 1, Sandeep Shaina 1, Abhishek Sengupta 2, Ashish Jaiman 1 *
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1 Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
2 Department of Orthopaedics, Sports Injury Centre, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 6, pp. 55-59.
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Introduction: Although the prevalence of intercarpal ligament injuries with distal radius fractures ranges from 0.5 to 75 percent, these injuries are often missed by the untrained eye. Currently, wrist arthroscopy is considered gold standard for diagnosis and treatment, but in Indian setting it is an impractical proposition. Scapho-lunate and luno-triquetral injuries can be identified on X rays easily by Gilula’s arc, scapholunate distance and angle, carpal height ratio etc. The aim of this study is to estimate the prevalence of intercarpal ligament injuries in distal radius (DER) fractures and determine their functional outcome at one year.
Material and methods: The study was conducted over 18 months at VMMC and Safdarjung Hospital. Patients with distal radius fractures were subjected to wrist X rays in 100% magnification and earlier mentioned parameters were measured. Patients who needed surgery were operated for fracture DER. Immediate post-operative X rays and X rays at 1 year were compared with that of the contralateral wrist. Patients’ clinical outcomes like range of motion, grip strength, quick DASH score and pain on VAS were measured at one year to assess the clinical outcome.
Results: The study population was of 103 patients. Prevalence of intercarpal injuries in patients with DER fractures was 11.7%. Out of these 12 patients, 50% had broken Gilula’s arc, 66.6% had increased scapho-lunate distance and 42% had increased scapho-lunate angle. Carpal height ratio was significantly less in patients with intercarpal ligament injuries at one year. Similarly, functional outcome was worse in these patients at one year.
Conclusion: Intercarpal injuries are associated with worse outcomes in patients with fracture DER. These injuries can reliably diagnosed on X rays using the parameters mentioned. Since the prevalence is quite high, we should learn to diagnose them early, so that patients can be explained about the prognosis of their injury.


Verma N, Sharma B, Shaina S, Sengupta A, Jaiman A. Incidence and functional outcome of inter-carpal ligament injuries associated with fractures of distal radius. J CLIN MED KAZ. 2023;20(6):55-9.


  • van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone. 2001; 29(6):517-22.
  • Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord. 2007; 8:48.
  • Mellstrand-Navarro C, Pettersson HJ, Tornqvist H, Ponzer S. The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study. Bone Joint J. 2014; 96-B(7):963-9.
  • Rosenthal DI, Schwartz M, Phillips WC, Jupiter J. Fracture of the radius with instability of the wrist. AJR Am J Roentgenol. 1983; 141(1):113-6.
  • Castaing J. Recent fractures of the lower extremity of the radius in adults. Rev Chir Orthop Reparatrice Appar Mot. 1964; 50:581-696.
  • Richards RS, Bennett JD, Roth JH, Milne K Jr. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am. 1997; 22(5):772-6.
  • Fowler TP. Intercarpal Ligament Injuries Associated With Distal Radius Fractures. J Am Acad Orthop Surg. 2019; 27(20):e893-e901.
  • Laulan J, Bismuth JP. Intracarpal ligamentous lesions associated with fractures of the distal radius: outcome at one year. A prospective study of 95 cases. Acta Orthop Belg. 1999; 65(4):418-23.
  • Weiss AP, Akelman E, Lambiase R. Comparison of the findings of triple-injection cinearthrography of the wrist with those of arthroscopy. J Bone Joint Surg Am. 1996; 78(3):348-56.
  • Linn MR, Mann FA, Gilula LA. Imaging the symptomatic wrist. Orthop Clin North Am. 1990; 21(3):515-43.
  • Schimmerl-Metz SM, Metz VM, Totterman SM, Mann FA, Gilula LA. Radiologic measurement of the scapholunate joint: implications of biologic variation in scapholunate joint morphology. J Hand Surg Am. 1999; 24(6):1237-44.
  • Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am. 1972; 54(8):1612-32.
  • Desai MJ, Kamal RN, Richard MJ. Management of Intercarpal Ligament Injuries Associated with Distal Radius Fractures. Hand Clin. 2015; 31(3):409-16.
  • Masarat Jehan, Nadeem Ali, Mohammad Saleem Itoo, Shaheen Shahdad, Altaf Ahmad Kawoosa. Carpal height ratio in Kashmiri population: a study of one hundred and twenty wrist radiographs. Int J Anat Res. 2019; 7(1.3):6314-6318.
  • Masiero F, Fagioli I, Truppa L, Mannini A, Cappello L, Controzzi M. Looking for Synergies in Healthy Upper Limb Motion: A Focus on the Wrist. IEEE Trans Neural Syst Rehabil Eng. 2023; 31:1248-1257.
  • Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, Fainsinger R, Aass N, Kaasa S; European Palliative Care Research Collaborative (EPCRC). Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011; 41(6):1073-93.
  • The quick DASH outcome measure. Available at, Accessed December 10, 2020.
  • Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001; 14(2):128-46.
  • Beaton DE, Davis AM, Hudak P, Mcconnell S. The DASH (Disabilities of the Arm, Shoulder and Hand) Outcome Measure: What do we know about it now? The British Journal of Hand Therapy. 2001; 6(4):109-118.
  • Swart E, Tang P. The Effect of Ligament Injuries on Outcomes of Operatively Treated Distal Radius Fractures. Am J Orthop (Belle Mead NJ). 2017; 46(1):E41-E46.
  • Forward DP, Lindau TR, Melsom DS. Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am. 2007; 89(11):2334-40.
  • Roulet S, Ardouin L, Bellemère P, Leroy M. Scapholunate, lunotriquetral and TFCC ligament injuries associated with intraarticular distal radius fractures: Arthroscopic assessment and correlation with fracture types. Hand Surg Rehabil. 2020; 39(2):102-106.
  • Ogawa T, Tanaka T, Yanai T, Kumagai H, Ochiai N. Analysis of soft tissue injuries associated with distal radius fractures. BMC Sports Sci Med Rehabil. 2013; 5(1):19.
  • Geissler WB. Arthroscopically assisted reduction of intra-articular fractures of the distal radius. Hand Clin. 1995; 11(1):19-29.
  • Nattrass GR, King GJ, McMurtry RY, Brant RF. An alternative method for determination of the carpal height ratio. J Bone Joint Surg Am. 1994; 76(1):88-94.
  • Kasapinova K, Kamiloski V. Influence of associated lesions of the intrinsic ligaments on distal radius fractures outcome. Arch Orthop Trauma Surg. 2015; 135(6):831-8.