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J Wrist Surg 2023; 12(01): 056-062
DOI: 10.1055/s-0042-1757779
Scientific Article

Long-term Outcomes following Operative Management of Pediatric Scapholunate Ligament Injuries

Robert J. van Kampen    *
1   Division of Hand Surgery, Mayo Clinic, Rochester, Minnesota
,
Paige M. Fox   *
1   Division of Hand Surgery, Mayo Clinic, Rochester, Minnesota
,
Heather L. Baltzer 
1   Division of Hand Surgery, Mayo Clinic, Rochester, Minnesota
,
Steven L. Moran
1   Division of Hand Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations Funding No funding was received for this work.
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Abstract

Background Scapholunate (SL) ligament injuries are rarely diagnosed in children. This study reports the outcomes of surgically treated SL ligament injuries in patients younger than 18 years.

Methods A retrospective review was performed on 20 pediatric patients with SL ligament injuries. Records were reviewed for preoperative and postoperative radiographic data, intraoperative findings, classifications of interosseous ligament injury, and postoperative course.

Results Thirteen girls and seven boys sustained SL injuries requiring operative intervention and were followed for an average of 26 months. Magnetic resonance imaging (MRI) was performed in 15 patients, which revealed an SL tear in 7 patients. Arthroscopically, SL injuries were classified as Geissler grade III in 12 patients and grade IV in 5 patients. Based on the Mayo Wrist Score, nine patients had excellent or good results, while six demonstrated fair results. The mean wrist flexion–extension arc was 109 degrees, while the mean grip strength was 82% of the unaffected side. Patients treated >1 year following injury had significantly decreased grip strength and Mayo Wrist Score.

Conclusion In this study, worse results were seen in children with a protracted course prior to treatment of an SL injury. A high index of suspicion is necessary to detect an SL injury in the younger age group and should be in the differential for those with persistent dorsal wrist pain, tenderness over the dorsal SL joint, and/or positive Watson's test. MRI may assist in diagnosis but is not definitive to rule out injury. Arthroscopy is valuable to determine the extent of injury.

Keywords

children - ligament - pediatric - scapholunate - wrist

Statement of Human Rights

This study was performed in accordance with the guidelines as described in the 1975 Declaration of Helsinki, as revised in 2008, and was initiated after IRB review and subsequent approval.


Statement of Informed Consent

Informed consent was waived based on minimum risk under the recommendation of the IRB review panel.


* Combined first author.




Publication History

Received: 25 March 2021

Accepted: 08 September 2022

Article published online:
09 November 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 1972; 54 (08) 1612-1632
    CrossrefPubMedGoogle Scholar
  • 2 Taleisnik J. The ligaments of the wrist. J Hand Surg Am 1976; 1 (02) 110-118
    CrossrefPubMedGoogle Scholar
  • 3 Taleisnik J. Post-traumatic carpal instability. Clin Orthop Relat Res 1980; (149) 73-82
    PubMedGoogle Scholar
  • 4 Russell TB. Inter-carpal dislocations and fracture-dislocations; a review of 59 cases. J Bone Joint Surg Br 1949; 31B (04) 524-531 , illust
    CrossrefPubMedGoogle Scholar
  • 5 Dautel G, Merle M. Scapholunate dissociation in the skeletally immature carpus. J Hand Surg [Br] 1997; 22 (02) 173-174
    CrossrefPubMedGoogle Scholar
  • 6 Cook PA, Kobus RJ, Wiand W, Yu JS. Scapholunate ligament disruption in a skeletally immature patient: a case report. J Hand Surg Am 1997; 22 (01) 83-85
    CrossrefPubMedGoogle Scholar
  • 7 Zimmerman NB, Weiland AJ. Scapholunate dissociation in the skeletally immature carpus. J Hand Surg Am 1990; 15 (05) 701-705
    CrossrefPubMedGoogle Scholar
  • 8 Gerard FM. Post-traumatic carpal instability in a young child. A case report. J Bone Joint Surg Am 1980; 62 (01) 131-133
    CrossrefPubMedGoogle Scholar
  • 9 Watson HK, Weinzweig J, Zeppieri J. The natural progression of scaphoid instability. Hand Clin 1997; 13 (01) 39-49
    CrossrefPubMedGoogle Scholar
  • 10 Dautel G, Goudot B, Merle M. Arthroscopic diagnosis of scapho-lunate instability in the absence of X-ray abnormalities. J Hand Surg [Br] 1993; 18 (02) 213-218
    CrossrefPubMedGoogle Scholar
  • 11 Kaawach W, Ecklund K, Di Canzio J, Zurakowski D, Waters PM. Normal ranges of scapholunate distance in children 6 to 14 years old. J Pediatr Orthop 2001; 21 (04) 464-467
    CrossrefPubMedGoogle Scholar
  • 12 Geissler WB, Freeland AE. Arthroscopically assisted reduction of intraarticular distal radial fractures. Clin Orthop Relat Res 1996; (327) 125-134
    CrossrefPubMedGoogle Scholar
  • 13 Weiss AP, Sachar K, Glowacki KA. Arthroscopic debridement alone for intercarpal ligament tears. J Hand Surg Am 1997; 22 (02) 344-349
    CrossrefPubMedGoogle Scholar
  • 14 Whipple TL. The role of arthroscopy in the treatment of scapholunate instability. Hand Clin 1995; 11 (01) 37-40
    CrossrefPubMedGoogle Scholar
  • 15 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
    CrossrefPubMedGoogle Scholar
  • 16 Taleisnik J. Current concepts review. Carpal instability. J Bone Joint Surg Am 1988; 70 (08) 1262-1268
    CrossrefPubMedGoogle Scholar
  • 17 Ruby LK. Carpal instability. Instr Course Lect 1996; 45: 3-13
    PubMedGoogle Scholar
  • 18 Linscheid RL, Dobyns JH, Beckenbaugh RD, Cooney III WP, Wood MB. Instability patterns of the wrist. J Hand Surg Am 1983; 8 (5 Pt 2): 682-686
    CrossrefPubMedGoogle Scholar
  • 19 Ruch DS, Poehling GG. Arthroscopic management of partial scapholunate and lunotriquetral injuries of the wrist. J Hand Surg Am 1996; 21 (03) 412-417
    CrossrefPubMedGoogle Scholar
  • 20 Light TR. Injury to the immature carpus. Hand Clin 1988; 4 (03) 415-424
    CrossrefPubMedGoogle Scholar
  • 21 Alt V, Gasnier J, Sicre G. Injuries of the scapholunate ligament in children. J Pediatr Orthop B 2004; 13 (05) 326-329
    CrossrefPubMedGoogle Scholar
  • 22 Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 1987; (214) 136-147
    PubMedGoogle Scholar
  • 23 Terry CL, Waters PM. Triangular fibrocartilage injuries in pediatric and adolescent patients. J Hand Surg Am 1998; 23 (04) 626-634
    CrossrefPubMedGoogle Scholar
  • 24 Garcia-Elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am 2006; 31 (01) 125-134
    CrossrefPubMedGoogle Scholar
  • 25 Blatt G. Capsulodesis in reconstructive hand surgery. Dorsal capsulodesis for the unstable scaphoid and volar capsulodesis following excision of the distal ulna. Hand Clin 1987; 3 (01) 81-102
    PubMedGoogle Scholar
  • 26 Moran SL, Ford KS, Wulf CA, Cooney WP. Outcomes of dorsal capsulodesis and tenodesis for treatment of scapholunate instability. J Hand Surg Am 2006; 31 (09) 1438-1446
    CrossrefPubMedGoogle Scholar
  • 27 Rohman EM, Agel J, Putnam MD, Adams JE. Scapholunate interosseous ligament injuries: a retrospective review of treatment and outcomes in 82 wrists. J Hand Surg Am 2014; 39 (10) 2020-2026
    CrossrefPubMedGoogle Scholar
  • 28 Nienstedt F. Treatment of static scapholunate instability with modified Brunelli tenodesis: results over 10 years. J Hand Surg Am 2013; 38 (05) 887-892
    CrossrefPubMedGoogle Scholar
  • 29 Soong M, Merrell GA, Ortmann IV F, Weiss AP. Long-term results of bone-retinaculum-bone autograft for scapholunate instability. J Hand Surg Am 2013; 38 (03) 504-508
    CrossrefPubMedGoogle Scholar
  • 30 Melone Jr CP, Polatsch DB, Flink G, Horak B, Beldner S. Scapholunate interosseous ligament disruption in professional basketball players: treatment by direct repair and dorsal ligamentoplasty. Hand Clin 2012; 28 (03) 253-260 , vii
    CrossrefPubMedGoogle Scholar
  • 31 Chabas JF, Gay A, Valenti D, Guinard D, Legre R. Results of the modified Brunelli tenodesis for treatment of scapholunate instability: a retrospective study of 19 patients. J Hand Surg Am 2008; 33 (09) 1469-1477
    CrossrefPubMedGoogle Scholar
  • 32 Pomerance J. Outcome after repair of the scapholunate interosseous ligament and dorsal capsulodesis for dynamic scapholunate instability due to trauma. J Hand Surg Am 2006; 31 (08) 1380-1386
    CrossrefPubMedGoogle Scholar
  • 33 Pyle SI, Greulich WW. Radiographic Atlas of Skeletal Development of the Hand and Wrist. Stanford, CA: Stanford University Press; 1959. :16–17
    Google Scholar
  • 34 Leicht P, Mikkelsen JB, Larsen CF. Scapholunate distance in children. Acta Radiol 1996; 37 (05) 625-626
    CrossrefPubMedGoogle Scholar
  • 35 Earp BE, Waters PM, Wyzykowski RJ. Arthroscopic treatment of partial scapholunate ligament tears in children with chronic wrist pain. J Bone Joint Surg Am 2006; 88 (11) 2448-2455
    CrossrefPubMedGoogle Scholar
  • 36 Schädel-Höpfner M, Iwinska-Zelder J, Braus T, Böhringer G, Klose KJ, Gotzen L. MRI versus arthroscopy in the diagnosis of scapholunate ligament injury. J Hand Surg [Br] 2001; 26 (01) 17-21
    CrossrefPubMedGoogle Scholar
  • 37 Kozin SH. The role of arthroscopy in scapholunate instability. Hand Clin 1999; 15 (03) 435-444 , viii
    CrossrefPubMedGoogle Scholar
  • 38 Walsh JJ, Berger RA, Cooney WP. Current status of scapholunate interosseous ligament injuries. J Am Acad Orthop Surg 2002; 10 (01) 32-42
    CrossrefPubMedGoogle Scholar