{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:44:59Z","timestamp":1791809099545,"version":"4.3.4"},"reference-count":53,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To determine the reliability and diagnostic accuracy of fluoroscopic parameters for diagnosis and staging of scapholunate (SL) instability in distal radius fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between May 2021 and March 2024, intraoperative fluoroscopic assessments were performed after fixation of unstable distal radius fractures. Imaging included anteroposterior, clenched\u2010fist anteroposterior\u2010ulnar deviation, true lateral, and modified scaphoid shift views. Wrist arthroscopy served as the reference standard, with staging according to Geissler (GI\u2010GIV) and European Wrist Arthroscopy Society (EI\u2010EV) classifications. Fluoroscopic parameters\u2014SL gap, SL\u2010ulnar deviation gap, SL translation, scaphoradius (SR) translation, SL angle, delta\u2010SL angle, and delta\u2010SR angle\u2014were analyzed for intra\u2010 and interobserver reliability and diagnostic accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty\u2010eight wrists (38 men, 50 women) were included. Fluoroscopic parameters differed significantly across SL instability stages. A staging algorithm was developed using parameters with high intra\u2010 and interobserver reliability (intraclass correlation coefficient\u2009&gt;\u20090.89) and good diagnostic accuracy (area under the receiver\u2010operating characteristic [AUC], 0.71\u20101.00). The SL angle differentiated G0\u2010II, GIII, and GIV instability, with cutoff values of 60\u00b0 (AUC 0.74) and 74\u00b0 (AUC 0.97). An SL angle\u2009&lt;\u200960\u00b0 or delta\u2010SL angle\u2009\u2264\u20094\u00b0, combined with delta\u2010SR angle\u2009&gt;\u200911\u00b0 (AUC 0.71), indicated non\u2010SL instability (G0\/E0), whereas delta\u2010SR angle\u2009\u2264\u200911\u00b0 indicated GI\u2010II\/EI\u2010II instability. A delta\u2010SL angle\u2009&gt;\u20094\u00b0 differentiated EIIIA from G0\u2010II\/E0\u2010II (AUC 0.82) and EIIIB\u2010C (AUC 0.88). Delta\u2010SR angle\u2009\u2264\u20095\u00b0 differentiated EIIIB\u2010C from EIIIA (AUC 1.00). SL\u2010ulnar deviation gap\u2009\u2265\u20092.9\u2009mm, SL translation\u2009\u2265\u20091.8\u2009mm, or SR translation\u2009\u2265\u20092.5\u2009mm differentiated EIIIC from EIIIB (AUC 0.89\u20101.00). Advanced instability (GIV\/EIV\/V) was indicated by SL gap\u2009\u2265\u20092.5\u2009mm, SL\u2010ulnar deviation gap\u2009\u2265\u20093.2\u2009mm, or SL translation\u2009\u2265\u20092.4\u2009mm (AUC 0.86\u20100.95).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Fluoroscopic parameters identified in this study show high reliability and good diagnostic accuracy for diagnosis and staging of SL instability in distal radius fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level II, diagnostic study of consecutive patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/arj.70599","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T11:51:32Z","timestamp":1791805892000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Algorithmic Approach to the Diagnosis and Staging of Scapholunate Instability in Distal Radius Fractures Using 7 Fluoroscopic Parameters Shows High Reliability and Accuracy"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4314-375X","authenticated-orcid":false,"given":"Thanapong","family":"Waitayawinyu","sequence":"first","affiliation":[{"name":"Hand and Microsurgery, Department of Orthopaedics, Faculty of Medicine Thammasat University  Pathumthani Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petai","family":"Sopasilapa","sequence":"additional","affiliation":[{"name":"Hand and Microsurgery, Department of Orthopaedics, Faculty of Medicine Thammasat University  Pathumthani Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9470-888X","authenticated-orcid":false,"given":"Punnawit","family":"Pinitchanon","sequence":"additional","affiliation":[{"name":"Hand and Microsurgery, Department of Orthopaedics, Faculty of Medicine Thammasat University  Pathumthani Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5529-2165","authenticated-orcid":false,"given":"Chinnakart","family":"Boonyasirikool","sequence":"additional","affiliation":[{"name":"Hand and Microsurgery, Department of Orthopaedics, Faculty of Medicine Thammasat University  Pathumthani Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"2175","DOI":"10.1016\/j.jhsa.2012.07.035","article-title":"Scapholunate instability: Current concepts in diagnosis and management","volume":"37","author":"Kitay A","year":"2012","journal-title":"J Hand Surg Am"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/S0363-5023(83)80246-9","article-title":"Instability patterns of the wrist","volume":"8","author":"Linscheid RL","year":"1983","journal-title":"J Hand Surg Am"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1016\/j.jhsa.2023.05.013","article-title":"Scapholunate instability: Diagnosis and management \u2013 Anatomy, kinematics, and clinical assessment \u2013 Part 1","volume":"48","author":"Wessel LE","year":"2023","journal-title":"J Hand Surg Am"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.jhsa.2005.10.011","article-title":"Three\u2010ligament tenodesis for the treatment of scapholunate dissociation: Indications and surgical technique","volume":"31","author":"Garcia\u2010Elias M","year":"2006","journal-title":"J Hand Surg Am"},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.jhsg.2024.11.011","article-title":"Wrist kinetics post\u2010scapholunate dissociation: Experimental and computational analysis of scapholunate interosseous ligament injury","volume":"7","author":"Kim S","year":"2024","journal-title":"J Hand Surg Glob Online"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1177\/1753193415616939","article-title":"Functional kinematics of the wrist","volume":"41","author":"Rainbow MJ","year":"2016","journal-title":"J Hand Surg Eur"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.2106\/00004623-197254080-00003","article-title":"Traumatic instability of the wrist. 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