Presentation
Persistent wrist pain months after distal radial fracture.
Patient Data
There is evolving but incomplete bony union across the intra-articular distal radial fracture, with ongoing volar displacement of the distal fragment and mild radial shortening. Low grade edema about the fracture lines persists. There is also a small ulnar styloid fragment.
Widening of the scapholunate interval with a step in the alignment of the scaphoid and lunate, (1.5 millimeter proximal displacement of the scaphoid relative to the lunate). Full thickness tear extends through volar and membranous portions, and incompletely through the dorsal band.
Relative dorsal rotation of lunate suggests dorsal intercalated segmental instability (DISI), although this would be better confirmed by plain films.
Torn styloid attachment of the triangular fibrocartilage and intermediate signal in the foveal attachment consistent with previous tear of the ulnar attachments of the triangle fibrocartilage. The central portion is thinned and mildly irregular.
Comment:
Healing intra-articular distal radial fracture with ongoing volar displacement of the distal fragment. Full-thickness scapholunate ligamentous tear with a small step in the alignment between scaphoid and lunate. Previous tear of the ulnar attachments of the triangular fibrocartilage.
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