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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Scaphoid fracturs with scapho-lunate ligament involvement: instability or ligamentous laxity? Role of arthroscopy and pinning

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  • presenting/speaker Federico Pilla - Rizzoli Orthopaedic Institute, Bologna, Italy
  • Vito Duca - Orthopaedic Institute, Sassuolo, Italy
  • Norman Della Rosa - OU of Hand Surgery, Modena, Italy
  • Giulia Colzani - OU of Hand Surgery, Modena, Italy
  • Roberto Adani - OU of Hand Surgery, Modena, Italy

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-651

doi: 10.3205/19ifssh0967, urn:nbn:de:0183-19ifssh09675

Published: February 6, 2020

© 2020 Pilla et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: The aim of this study is to evaluate the role of arthroscopy in the treatment of scaphoid fractures; and in particular we investigated if ligament alterations found arthroscopically corresponded to actual lesions or just laxity. Furthermore, we evaluated if treatment through the pinning of the scapholunate joint can alter the results.

Methods: We performed a retrospective study on 39 patients that underderwent surgery from 2010 to 2016 for scaphoid fractures Patients were divided in 4 groups (A, B, C, D) based on the surgical technique adopted and the finding of a lesion of the scapholunate ligament:AFixation with a percutaneous screw without the use of arthroscopy, B Arthroscopy assisted fixation with a percutaneous screw without signs of scapholunate ligament lesions,C Arthroscopy assisted fixation with a percutaneous screw with signs of partial scapholunate ligament lesions, treated through pinning, D Arthroscopy assisted fixation with a percutaneous screw with signs of partial scapholunate ligament lesions, not treated.

The inclusion criteria were B-type scaphoid body fractures (B1 and B2). Exclusion criteria were proximal fractures, pseudarthrosis or severe arthritic degeneration

Results and Conclusions: of 29 cases treated with arthroscopy assistance only in 9 cases there were no scafolunate ligament lesions. In the other 20 cases, according to the Geissler classification, there were 2 type I lesions, 5 type II lesions and 13 type III lesions, no type IV lesion was detected. Our results show the pain to be modest (VAS scale). The ROM results show a small difference(the average ROM 6° in group A, 3,89° in group B, 10° in group C, and 7,3° in group D).

The results were on average good to excellent in all groups.

In our study groups we observed no statistically significant differences of the outcomes analyzed.

From our experience and results the treatment of acute partial scapholunate lesions through pinning is not necessary. The differences between our 4 study groups are not statistically significant and so the 4 treatment options should be considered equal.