Arthroscopic criteria for dating wrist sprains.

OBJECTIVES

Dating wrist sprains has therapeutic and medicolegal importance. The authors propose a study validating three arthroscopic criteria to date the trauma.

METHODS

The authors analyzed statistically one hundred arthroscopies performed between 1999 and 2008 after wrist sprains. They suggest three criteria to date the injury. They are: turbidity of synovial fluid (assessed T0 to T4), hemorrhagic infiltration of the synovium (evaluated S0 to S2), and the aspect of the articular cartilage (assessed C0 to C4).

RESULTS

The importance of turbidity is significant with P<0.001. The importance of synovitis is significant with P<0.001. The extent of cartilage degradation is significant with P<0.01. These three criteria have also a very significant predictability. The authors distinguish four posttraumatic periods: the immediate period, less than 2 weeks, corresponding to T3/T4, S2, C0; the acute period from 2 to 6 weeks, corresponding to T1/T2, S1, C1/C2; the subacute period from 6 weeks to 6 months, corresponding to T0, S1, C3; the chronic period beyond 6 months, corresponding to T0, S0, C4. The association T2/T4, S2, C4 is clearly an acute injury with a previous pathologic situation.

CONCLUSIONS

The arthroscopic criteria for dating a wrist sprain are simple to estimate. They are used to define the immediate, acute, subacute or chronic posttraumatic periods, and a previous pathologic situation. The choice of surgical indication is facilitated and an objective estimation of the length of lesion is useful in the forensic setting.