Age / Sex : 25 / M

Age / Sex : 25/M

Chief complaint : 6주 전부터 Lt. wrist pain 발생하여 내원

Disruption of the SLL with DISI

Discussion

Findings: (a) AP radiograph of the wrist shows wide separation of the sacapholunate distance. The shape of the lunate is triangular and overlapped with capitates. There shows shortening of the scaphoid with cortical ring sign. (b) Lateral radiograph shows dorsiflexion of the lunate and marked increased scapholunate angle with about 118°

Differential Diagnosis:

Diagnosis: Disruption of the SLL with DISI

Discussion: Carpal stability is maintained by extrinsic (radiocarpal) and intrinsic (intercarpal) ligaments. Major extrinsic ligaments are radioscaphocapitate, radiolunotriquetral, short radiolunate, and dorsal radiocarpal ligament. The most important intrinsic ligament is scapholunate and lunotriquetral ligament. There shows loss of the normal alignment of the carpal bones in the carpal instability, for example in case of the unstable fracture of the scaphoid, scapholunate dissociation, and lunotriquetral dissociation. Scapholunate ligament (SLL) is the strongest and stiffest of the interosseous ligaments. Scapholunate dissociation is the most common carpal instability and occurs as an isolated injury or with distal radius or scaphoid fractures. There shows tenderness in the anatomic snuffbox on physical examination. Rupture site is most often at scaphoid attachment sites because fibers less dense. In DISI pattern, the scapholunate angle measures more than 60° and capitolunate angle more than 30°.