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Abstract

We thank Drs Andersson and Karlsson for their letter, which highlights the clinical relevance of our paper (Sun et al., 2019). We see this paper as an extension of our previously published work on CT scans of distal radius fractures (Mandziak et al., 2011). We have identified that distal radius fractures are significantly more likely to occur between the ligaments (Mandziak et al., 2011; Bain et al., 2013), especially in low velocity injuries. Therefore, each fragment will have its own ligament. We have identified that these ligaments are important in the initiation of the fracture, the settling of the fracture, and in establishing a pathoanatomic-based treatment plan (MacLean and Bain, 2019). This Osteoligamentous concept is important to understand in the assessment and treatment of all fractures (MacLean and Bain, 2019). In our recent paper (Sun et al., 2019), we identified significant widening in the scapholunate interval in specific 2-part distal radial fracture sub-types; namely radial styloid oblique, dorsal ulnar corner types. We agree that it is important to preoperatively assess the distal radius fracture and signs of carpal instability. We also agree with the authors that wrist arthroscopy is a valuable intra-operatively tool for diagnosis and assessment of the reduction. We support the important work of Lindau et al. (1997), where he provides an understanding of the longer-term outcome of these associated injuries. However, we feel that our work has highlighted the importance of sub-group analysis, and we believe that further research is required to better define which osteoligamentous injuries have a poorer prognosis. Our study highlights the important pathoanatomy of osteoligamentous injuries of the distal radius, appreciating both the osseous and soft tissue component. From a greater understanding of these osteoligamentous injuries, we can hopefully provide a more focused treatment plan.