Extrinsic Ligament Injuries (CIND) in Distal Radius Fractures

Distal radius fractures are associated with high incidence of intrinsic ligamentous (e.g. scapholunate and lunotriquetral ligament) injuries.  Yet not all of them needs to be treated.  We identified a specific group of distal radius fractures of which concomitant extrinsic ligaments are disrupted either as avulsion fractures or intra-substance tears.  They are named CIND-Trauma.  Patients were usually young and sustained high energy of trauma.  Even in cases where fracture fixation was performed adequately, the entire proximal row of carpal bones might rotate either in the dorsal or volar direction, depending on the integrity of each extrinsic ligaments.   Surgical repair and temporary immobilization are recommended to achieve good functional outcome.  In delayed presentation, limited arthrodesis may be necessary.