Materials & Methods: Patients treated with either the RASL screw or IB technique for a complete, non-repairable SL injury without arthritis, were identified retrospectively. Radiographic (SL angle, SL gap, and dorsal scaphoid translation) and clinical data including range of motion (ROM), pain, complications, revision surgeries were recorded pre-operatively, immediate post-operatively, and at final follow-up. Patients with less than 6 months of follow-up were excluded. Bivariate analyses (paired t-test for continuous variables and chi-square for categorical variables) were utilized to compare outcomes. Alpha was set to 0.05.

Results: Twenty-five patients (19 male, 6 female) with an average age of 43 years (range 23-66) were identified (RASL=14 and IB=11). The average time to surgery was 29 weeks with an average of 16 months (range: 6.5 months – 3.5 years) follow-up. There were no differences between groups in radiographic parameters or ROM at final follow-up, except for a smaller SL gap at final follow-up in RASL patients (1.5 mm vs. 2.4 mm, p=0.03) (Table 1). Ultimately, 4 patients in the RASL group required additional procedures for screw removal secondary to screw breakage (n=1) or screw migration/loosening (n=3) (Figure 1). One patient in the IB group had complete failure/diastasis post-operatively and 36% (4/11) patients had osteolysis on their final follow-up radiographs (Figure 2). Post-operatively, all patients reported an improvement in pain, however, one patient in the RASL group had severe persistent pain and required further surgery in the form of wrist denervation.

Conclusions: RASL and IB have comparable post-operative outcomes when in the setting of irreparable SL injuries. It is important to note complications including screw breakage and loosening associated with the RASL technique and recurrent diastasis/gapping and high rate of osteolysis with the IB technique, although this has an unknown clinical significance.