Radiographic Incidence and Functional Outcomes of Scapho-Lunate Ligament Injuries undergoing Volar Plate Fixation of Distal Radius Fractures: A Prospective Analysis
Asif Ilyas, MD, Orthopaedics, Rothman Institute at Thomas Jefferson University, Philadelphia, PA and William Wang, MD, Thomas Jefferson University, Philadelphia, PA
Scapholunate (SL) ligament injuries can occur concomitantly with distal radius fractures. Chronic SL instability is thought to initiate scapholunate advanced collapse (SLAC) and repair of an acute SL injury may theoretically prevent carpal instability and subsequent disease progression. However, since it is unclear how many SL deficient wrists remain asymptomatic and which ones go on to develop a symptomatic SLAC wrist, management of acute SL injury in the setting of distal radius fractures (DRF) remains controversial. The purpose of the study is to identify the incidence of acute and late presentation of SL injuries in DRF, identify associations between fracture pattern and SL injuries and to determine the clinical and functional outcomes of DRF with a concomitant and untreated SL injury.
One hundred and seventeen patients with DRF, with and without SL widening, and treated with volar locked plating were prospectively enrolled. Per protocol, no SL ligament repairs or reconstructions were offered in any cases. Patients with DRF with radiographic criteria for an SL injury were compared with DRF without a radiographic SL injury. Patients were evaluated at 3 months and 1 year post-operatively where Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) and Patient-Rated Wrist Evaluation (PRWE) questionnaires were obtained. Independent student t-test and analysis of variance (ANOVA) was used to compare differences in continuous variables between the two cohorts.
Thirty-one (26.5%) patients were found to have SL widening. There was no difference in proportion of SL injury within AO fracture type A (32.6% versus 25.8%, p=0.48), type B (11.6% versus 12.9%, p=0.85), and type C (55.8% versus 61.3%, p=0.597). Patients with concomitant SL widening had less wrist extension at 3 months (52.4 degrees versus 60.8, p=0.034) and at 1 year (64.5 degrees versus 71.8, p=0.023). There were no differences in wrist flexion, supination, pronation, PRWE scores, and Quick Dash scores at 3 months and 1 year.
SL injury is a common concomitant injury associated with DRF undergoing surgical repair. No association with specific fracture pattern or SL injury type was identified. There are similar clinical outcomes between those with untreated SL widening compared to those without in the short-term. Further studies would be warranted to investigate the long-term effects of concomitant SL diastasis in surgically indicated DRF.
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