Presentation
Fall. Wrist pain.
Patient Data
Mild DISI alignment. Extensive chondrocalcinosis. Radiocarpal and first carpometacarpal joint osteoarthritis. No fracture was seen.
Clinical suspicion for a fracture was high. The patient was casted and sent for follow-up CT 7 days later.
Plaster cast.
Non-displaced intra-articular fracture of the dorsal distal radius, best seen on the sagittal reconstruction.
Widening of the scapholunate interval. DISI alignment. Severe radiolunate arthritis. Positive ulnar variance with ulnocarpal abutment and arthritis. Erosion of the ulnar styloid.
Severe first carpometacarpal osteoarthritis.
Small subchondral and subcortical lucencies throughout the carpus. Extensive chondrocalcinosis.
Case Discussion
This busy wrist is the manifestation of Hickam's dictum:
- extensive chondrocalcinosis consistent with CPPD
-
scapholunate dissociation
- widened scapholunate interval is presumably related to CPPD but could also be to prior traumatic injury (it appears chronic with severe radiolunate osteoarthritis)
- on the x-ray, the scapholunate widening is not well seen but in hindsight, the scaphoid has a volar tilt giving the signet ring appearance
- secondary (mild) DISI alignment
- ulnocarpal abutment, again appearing long-standing
- distal radius fracture, which was not seen on the initial x-ray although (again with hindsight) a small lucency is present