Aim. This study reviewed the efficacy of a CT arthrogram in clinical decision making for wrist disorders. Methods. Sixty four consecutive CT arthrograms done in a three year period at Glenfield Hospital were selected. All patients were referred by hand consultants at the Glenfield Hospital and all investigations were performed by a single senior musculoskeletal radiologist. CT arthrograms focussed on the following areas: scapholunate interosseous ligament (SLIL), lunotriquetral interosseous ligament (LTIL), peripheral and central triangular fibrocartilage complex (TFCC) tears, and articular surface disorders. Referral and clinic letters for all patients were obtained. We collected patient demographic detail, prescan diagnosis and clinical plan, CT arthrogram findings, postscan diagnosis and clinical plan and the final outcome. A decision was made whether the scan helped in the clinician's management plan and if so how it helped. Results. There were 35 male and 29 female patients with a mean age of 44.1 years. The right wrist was involved in 42 and the left in 22 patients. Sixty three of the 64 patients had their management based on the CT scan. In 54 of these the CT arthrogram either confirmed and calibrated the diagnosis or identified a new diagnosis. In 10 patients the scan was normal and allowed patient reassurance. Thirty six patients had ulnar sided problems, 20 had radial sided disorders and eight had midcarpal abnormality. The most common abnormality noted was a TFCC tear (24). The next most common was chondral damage/arthritis (14) followed by scapholunate interosseous ligament tear (12). The diagnosis was either confirmed and its extent established (31) or identified in addition to the primary diagnosis (19). Conclusions. The CT arthrogram is a helpful tool in the management of intra-articular wrist pathology. We found it to be useful in both confirming and calibrating the diagnosis and also diagnosing occult patho

Aim:. To assess the clinical outcomes of patients that had perilunate or lunate dislocations treated with either open or closed reduction and wiring without repair of the scapholunate interosseous ligament (SLIL). Background:. Current literature states that acute perilunate dislocations should be treated with open reduction and repair of the dorsal scapholunate ligament. This is to prevent dissociative carpal instability and potential long term degenerative arthrosis. Methods:. A retrospective review of patients who sustained a perilunate or lunate dislocation, with no associated radial or carpal fracture was conducted. All were treated by reduction and percutaneous wiring without repair of the SLIL. Patients were examined and data was collected regarding patient's pain, range of motion, grip strength, instability and return to work. All patients had a Mayo wrist score. Pre and post-surgical radiographs were assessed and the scapholunate distance, scapholunate angle and the radiolunate angle were measured. The presence of a high riding scaphoid and osteoarthritis was recorded. Results:. A total of 13 patients were included in the study, with an average follow up of 32 months. 92% of patients had no pain in their wrist at final follow up. Range of movement was 78% of the normal side. 70% of patients returned to work. 92% of patients had no clinical wrist instability. Grip strength was 82% of the opposite side. Radiographic assessment showed an average scapholunate distance of 2.6 mm, a scapholunate angle of 65° and radiolunate angle of 11°. One of the 13 patients had a high riding scaphoid. 23% of patients had arthritic changes of the carpus on plain radiographs. Of the 13 patients, 3 had excellent mayo scores, 4 good, and 6 fair. No patients had poor scores. Of the 13 patients reviewed 10 returned to work, those that did not were not able to due to other disabilities acquired at the time of their accident. Conclusion:. Acute management of perilunate dislocations with reduction and percutaneous wiring without repair of the SLIL, resulted in the majority of patients having a pain free, stable, mobile wrist with an above average Mayo wrist score and no arthritic change on radiographic assessment