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Long-Term Outcomes Following Operative Management of Pediatric Scapholunate Ligament Injuries
Paige M. Fox, MD, PhD; Robert J. van Kampen, MD; Heather L. Baltzer, MD; Steven L. Moran, MD
Mayo Clinic, Rochester, MN

Purpose: Scapholunate injury is rarely diagnosed in children. The current study reports the outcomes of surgically treated scapholunate (SL) ligament injuries in patients less than 18 years of age with surgically documented SL injury.

Methods: An IRB approved retrospective review was performed on 21 pediatric patients with SL ligament injuries. Average subject age was 15 (range, 11-17). Records were reviewed for pre-operative and post-operative radiographic data, and intraoperative findings, classifications of interosseous ligament injury and post-operative course. Post-operative outcomes were evaluated with Mayo Wrist scores

Results: Fourteen females and 7 males sustained SL injuries which required operative intervention. Twenty patients presented with dorsal wrist pain. Seven patients had a positive Watson shift test. MRI was performed in 15 patients; the radiologist interpretation indicated an SL tear in 7. Arthroscopy was performed in 18 patients. The SL injury was classified as Geissler grade II in 1 patient, III in 12 patients, and grade IV in 5 patients. The average follow-up period was 28 months, after which, 8 patients were pain free, 3 described pain only with heavy activity, 7 had mild pain with daily activities, 2 had moderate pain, and 1 patient required daily pain medication. Based on the modified Mayo wrist score, 8 patients had excellent or good results while 8 demonstrated fair results. The mean wrist flexion-extension arc was 111 degrees while the mean grip strength was 81% of the unaffected side. Patients treated >1 year following injury had significantly decreased grip strength and Mayo wrist score. (Figure 1.)

Conclusion: SL dissociation is an uncommon injury but can also occur in the pediatric age group. Within this study worse results were seen in children who had a protracted course prior to diagnosis. A high index of suspicion is necessary to detect an SL injury in the younger age group. SL injury should be within the differential in all children with persistent dorsal wrist pain, localized tenderness over the dorsal SL joint and/or positive Watson's test. MRI may assist in diagnosis but is not always sensitive. Arthroscopy is valuable to determine the extent of injury.
Figure 1. X-axis= Mayo Wrist Score; Y-axis= Number of patients. Early = treated within 1 year of injury; Late= treated >1 year after injury. Difference in average Mayo wrist score was statistically significant at 69 in the late treatment group versus 83 in the earlier treatment group (p= 0.004).

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