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Pediatric Scapholunate Ligament Injuries
Robert J. van Kampen, MD; Steven L. Moran, MD; Mayo Clinic
Robert J van Kampen, ROCHESTER, MN, USA

Introduction:Scapholunate ligament injuries are rare in the pediatric age group. For this reason also little is known about the treatment of these injuries. So far only a few case reports have been published, and one larger series about percutanous pinning of Geissler II injuries. We report our experience with open and closed surgical treatment of Geisler III and IV scapholunate ligament injuries in pediatric patients.

Methods:We performed a retrospective review of the medical records of all pediatric patients that were treated for scapholunate ligament injuries. 23 patients (10 boys) with aGeissler score III (10) or IV (7) or tear proven with open surgery (6) were included. Pre and postoperative data including mechanism of injury, range of motion, grip strength, pain and radiographic parameters were collected.

Results:The average age was 15.1 years (range 11.4-17.8). The average delay to surgery was 66 weeks (1-334). The mechanism of injury was fall on the outstretched hand (13), direct dorsal hit (6), axial load (1), and repetitive overuse (4). All patients had dorsal wrist pain at the level of the scapholunate joint. 14 had pain with Watson's maneuver; nine had a truly positive test. Seven had previous arthroscopic treatment for triangular-fibrocartilaginous-complex tears (4) and ganglia (3). Ten were shown to have static signs of diastasis, increased scapholunate angle and/or DISI deformity. Eight patients had associated fractures, four involving the scaphoid. Eight patients had associated TFCC injuries, six had lunotriquetral ligament injury. 17 patients underwent magnetic resonance imaging; ten were suggestive for scapholunateligament injury

Surgical treatments were percutanous pinning of the scapholunate joint (5), tri-ligament tenodesis (4), a form of dorsal capsulodesis (13) and/or direct repair of the dorsal scapholunate ligament (3), and volar capsulodesis for a volar tear (1). The average follow up was 100 weeks (16 – 359). The average Mayo Wrist Score (12 patients) changed from 69.1 (40-90) pre-operatively to 80.5 (60-90) postoperatively. 11 patients had no pain, 7 occasional mild, and 4 had moderate to severe pain. Patients with pre-operative limited range of motion and grip strength due to pain had improved functionality after surgery. In other cases strength and motion were reduced, but most patients were able to return to their daily activities.

Conclusion:Pediatric scapholunate ligament injuries do occur. The mechanism of injury is nonuniform and there is often a delay in diagnosis. Increased awareness of this injury pattern may improve outcome.

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