Sign Of Taleisnik

Figure 63—1. Anteroposterior (AP) (A) and lateral (B) radiographs of the patient's wrist with dorsal intercalated segment instability (DISI) of the wrist.

1. Scapholunate gap: The intercarpal distance between the scaphoid and lunate on the AP radiograph is increased, compared with the other intercarpal spacing. A scapholunate gap greater than 3 mm is considered diagnostic of a scapholunate dissociation. This scaphoid gap has been called the "Terry Thomas" sign after the famous English film comedian's dental diastema. This increase in the scapholunate intercarpal distance is most noticeable, both in biomechanical and clinical studies, in the AP supinated clenched fist radiographic view.

2. A shortened scaphoid: The scaphoid assumes a flexed posture as a result of its dissociation from the surrounding carpus and assumes a shorter appearance on the PA and AP radiographic views.

3. The cortical ring sign: The flexed posture of the scaphoid results in an end-on view of the scaphoid tubercle/distal scaphoid, which results in this more prominently visualized circular cortex of the scaphoid.

4. DISI pattern of the carpus: The scaphoid assumes a flexed and dorsally sub-luxed posture, the lunate assumes an extended and volar subluxed posture, and the capitate lies in a flexed posture.

5. Taleisnik's "V" sign: The intersection of the volar edge of the scaphoid outline when the scaphoid is flexed intersects with the volar margin of the radius at a more acute angle than the normal wrist in which there is a more gentle or wide C-shaped pattern of intersection.

Scapholunate dissociation can be seen alone or in combination with fractures. Carpal alignment should be routinely assessed in any distal radius fractures, including radial styloid fractures.

Arthrography can be utilized to assess the presence of ligamentous disruptions of the wrist. A wrist arthrogram, although helpful to identify ligamentous disruptions, is not able to characterize the size or degree of ligamentous disruption. Also of note is the fact that dissections of the wrist in cadavers demonstrate a 28% incidence of scapholunate interosseous ligament disruptions. In the dissections where both left and right wrists were evaluated, it was noted that if a scapholunate interosseous ligament disruption was seen on one side, there was a 66% incidence of disruption of this ligament on the contralateral side. Therefore, although reasonable as part of the workup, a positive arthrogram should not, in and of itself, be considered pathognomonic for scapholunate instability, particularly in the older population.

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