Cette étude prospective a eu pour buts de rechercher d'éventuelles lésions ligamentaires intracarpiennes contemporaines des fractures du poignet et susceptibles d'expliquer des résultats cliniques décevants, de rechercher des facteurs favorisants ces lésions et d'analyser leur impact sur les résultats fonctionnels.

Sur une période de un an, 40 patients présentant une fracture déplacée de l'extrémité distale du poignet, nécessitant un traitement chirurgical, ont fait l'objet d'un bilan arthrographique à la recherche de lésions ligamentaires intracarpiennes. Une première arthrographie de poignet a été effectuée lors de la synthèse de la fracture. Après obtention d'une consolidation osseuse, l'ablation du matériel d'ostéosynthèse a été accompagnée d'une seconde arthrographie. Tous les patients ont ensuite été revus avec un recul minimum de 1 an afin d'apprécier le résultat fonctionnel.

Des images arthrographiques anormales ont été observées dans 57 % des cas. La survenue de ces lésions n'a été influencée ni par le type de fracture, ni par l'importance du déplacement. Les résultats fonctionnels précoces n'ont pas été altérés par ces lésions. Enfin, seules les atteintes du ligament luno-pyramidal semblent avoir un pouvoir de guérison en cas d'immobilisation.

We performed a prospective study to search for arthrographic signs in favor of intracarpal ligament lesions occurring concomitantly with wrist fractures. We looked for a relationship between type of fracture and displacement and examined their impact on early functional outcome.

The series included 40 patients treated over a 1-year period. All 40 patients had a displaced wrist fracture requiring surgical treatment. A three-phase arthrography was performed during the initial operation in order to search for injuries involving the scapho-lunate, luno-pyramidal or triangular complex ligaments. A second arthrography was performed at the time the osteosynthesis material was removed. All patients were followed one year postperatively. Functional outcome was recorded at one year.

Abnormal images were found in 57% of the patients at the first arthrography. Injury to the triangular complex predominated, followed by combined injuries. There was no statistical correlation between type of fracture, degree of displacement, and presence of ligament lesions (p > 0.05). Lesions of the triangular fibrocartilaginous complex (TFCC) were significantly increased (p = 0.04) in the event of intra-articular fracture. Age and gender did not influence ligament injury. At one year, the functional outcome was statistically comparable between patients with and without ligament injury. At the second arthrography, we observed only five cases where cure of the luno-pyramidal ligament had been achieved.

Intracarpal ligament injuries associated with wrist fractures are frequent. Age had no effect on occurrence of ligament injury in our series, similar to findings reported by others. Likewise, the type of fracture had no effect. Data in the literature show that intra-articular fractures and highly-displaced fractures aggravate ligament injury. Our functional results at one year did not demonstrate any significant difference in patients with and without ligament injury. A 3 or 5-year follow-up might provide further insight. Nevertheless, neglected scapho-lunate lesions still have a bad reputation in the literature, leading us to search for such lesions and to provide adapted treatment in all patients aged less than 50 years presenting a displaced fracture of the wrist.