Incidence of Scapholunate Ligament Dissociation in Patients With Aspiration-Confirmed Gout

Purpose To determine the incidence of scapholunate (SL) dissociation in patients with aspiration-confirmed gout of the wrist and aspiration-confirmed gout in any joint excluding the wrist Methods Geisinger Medical Center uses the EPIC electronic medical record system, which maintains International Classification of Diseases, 9th Revision, Clinical Modification and Current Procedural Terminology coding information for every patient encounter in our hospital system We queried this electronic medical record system from 1998 to 2008 using the International Classification of Diseases, 9th Revision, Clinical Modification codes for gout as well as Current Procedural Terminology codes for aspiration of a minor, intermediate, or major joint We then evaluated medical records of patients meeting criteria for the presence of wrist x-rays We examined x-rays for SL interval, SL angle, and capitolunate angle and determined the incidence of SL dissociation in all patients with a diagnosis of gout confirmed by joint aspiration Results We reviewed a total of 1,105 cases, 159 patients met inclusion criteria Of 159 patients, 20 had aspiration-confirmed gout in the wrist We determined incidence using 2 definitions (I) one or more positive radiographic criteria for SL dissociation, and (2) two or more positive radiographic criteria The incidence of SL dissociation in wrists with aspiration-confirmed gout was 60% by definition 1 and 25% by definition 2 The average SL interval was 2 95 mm The remaining 139 patients had aspiration-confirmed gout in joints other than the wrist A total of 69 patients had 1 or more positive criteria for SL dissociation, whereas 18 had 2 or more positive criteria, making the incidence of SL dissociation 49 6% and 12 9%, respectively The average scapholunate interval was 2 28 mm The incidence of SL dissociation in patients with aspiration-confirmed gout in any joint was 50 9% and 14 5%, based on the above definitions Conclusions This study establishes the incidence of SL dissociation in patients with gouty arthropathy of the wrist as 60% and 25%, respectively, based on the above definitions In addition, our study suggests that, as a result of the systemic nature of gout, a patient with aspiration-confirmed gout at a joint remote from the wrist might have subclinical effects in the wrist, leading to SL dissociation over time (J Hand Surg 2010,35A 1938-1942 Copyright (C) 2010 by the American Society for Surgery of the Hand All rights reserved)