Three dimensional scapholunate distance assessment from biplanar radiographs: A feasibility study in clinical practice

Abstract

Introduction: Wrist ligament injuries present a significant challenge in orthopedic surgery. They primarily affect a young and active population. When left undiagnosed, they can lead to chronic pain, arthritic degeneration, and professional disabilities. The lack of objective pre- and postoperative tools limits effective patient follow-up. The aim of this study is to apply a 3D reconstruction method based on biplane radiographs of the hand and wrist to diagnose and monitor these ligament injuries.

Hypothesis: A personalized hand and wrist reconstruction created from biplane radiographs could enable the objective diagnosis and follow-up of carpal ligament pathologies.

Materials and methods: We included 30 healthy volunteers, and 12 patients suspected of having ligament injuries. Data acquisition was performed using a low-dose biplane radiography system (EOS). Bone reconstruction was conducted, and scapholunate (SL) distances were calculated between the neutral and clenched fist positions by determining bone centroids. The variations in SL distances in patients, both pre- and postoperatively, were compared to the values of the healthy volonteers cohort.

Results: In healthy volunteers, variations in SL distances between the neutral and clenched fist positions were significantly different depending on sex (0.1 mm in males, 0.5 mm in females) and lunate morphology. No statistically significant difference was observed between the healthy and preoperative groups (p = 0.165). However, a significant difference was found between preoperative and postoperative patients (p = 0.014).

Discussion: This study highlights the utility of personalized reconstruction in objectively assessing biomechanical alterations of the wrist and monitoring patients. However, the routine clinical application of this method requires technical improvements in terms of precision and automation.

Level of evidence: III; case-control study.

Keywords: 3D reconstruction; Hand; Kinematics; Low dose biplanar X-rays; Wrist.