Gantry-free cone-beam CT arthrography for diagnosis of scapholunate ligament injuries: accelerating the preoperative work-up in acute wrist trauma

Category	Detail
Condition	Scapholunate ligament (SLL) injuries associated with distal radius fractures
Key Mechanisms	Tears of the SLL, especially the dorsal segment, cause carpal instability leading to dorsal intercalated segment instability and palmar rotatory subluxation of the scaphoid
Target Population	Patients with acute wrist trauma and suspected SLL tears, particularly those with distal radius fractures
Care Setting	Emergency departments and tertiary-care hospitals during preoperative assessment

Distal radius fractures often mask concomitant SLL injuries which are difficult to detect with conventional radiography or CT alone
Gantry-free cone-beam CT (CBCT) arthrography combines fluoroscopy-guided contrast injection and high-resolution 3D imaging in one system
CBCT arthrography offers improved spatial resolution and a streamlined diagnostic workflow facilitating timely and accurate preoperative evaluation

Use fluoroscopy-guided intra-articular contrast injection into midcarpal and radiocarpal joints for arthrography
Perform CBCT imaging immediately after contrast injection using gantry-free extremity scanners for high-resolution 3D visualization
Interpret images with multiplanar reconstructions focusing on ligament integrity, especially the dorsal SLL segment

Timely identification of SLL tears to guide surgical planning and prevent secondary carpal collapse
Integrate CBCT arthrography into preoperative workup for distal radius fractures with suspected ligamentous injury

Monitor for secondary osteoarthritis and scapholunate advanced collapse in patients with untreated SLL insufficiency

Potential for missed SLL injuries if relying solely on conventional radiography or CT without arthrography
Radiation exposure from combined fluoroscopy and CBCT imaging should be minimized using optimized protocols

94 consecutive patients with acute wrist trauma undergoing CBCT arthrography

CBCT arthrography performed within days of trauma provides accurate assessment of SLL integrity, facilitating timely surgical decision-making

Employ a one-stop-shop approach combining fluoroscopy-guided contrast injection and CBCT imaging without repositioning the patient
Use a half-half mixture of iodine contrast medium and anesthetic for intra-articular injection
Position patients with arm abducted approximately 90° and hand in pronation to optimize joint access and imaging quality
Utilize high-resolution bone kernels and multiplanar reconstructions for detailed ligament visualization
Ensure experienced musculoskeletal radiologists interpret CBCT arthrograms independently and blinded to clinical data to reduce bias

Clinical Scorecard: Gantry-free cone-beam CT arthrography enhances the diagnosis of scapholunate ligament injuries, streamlining preoperative assessment in acute wrist trauma