Article
Do we need to treat a Grade 3 scapholunate ligament injury according to Geissler classification in acute Distal Radius Fractures? Results of rearthroscopy at the time of Implant removal
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Authors
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Rohit Arora
- University Hospital Innsbruck, Department of Trauma Surgery, Innsbruck, Austria
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Tobias Kastenberger
- University Hospital Innsbruck, Department of Trauma Surgery, Innsbruck, Austria
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Gernot Schmidle
- University Hospital Innsbruck, Department of Trauma Surgery, Innsbruck, Austria
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Markus Gabl
- University Hospital Innsbruck, Department of Trauma Surgery, Innsbruck, Austria
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Scapholunate (SL) ligament injuries in acute distal radius fractures (DRFs) are rare. While partial ruptures as Grade 1 and 2 according to Geissler are treated none-operatively and complete ruptures as Grade 4 are treated operatively there is no consensus weather or not Grade 3 injuries should be treated surgically at the time of fracture fixation. We report about the natural history of untreated Grade 3 SL ligament tears associated with acute DRFs.
Methods: Eleven patients (9 male and 2 female) with an average age of 56 years with acute DRF (all AO type C3) were treated using palmar plate fixation in 8 cases and dorsal plate fixation in 3 cases. In all patients an acute Grade 3 SL ligament injury was diagnosed arthroscopically. The SL ligament injuries were not treated in any of the patients. At the time of implant removal a rearthroscopy was performed to assess any progression of the SL ligament instability. Additionally radiological and clinical examination was assessed at the time of the last follow-up and compared to the uninjured side.
Results and Conclusions: The average follow-up time was 2.6 years. The wrist extension was 64°, flexion 57°, pronation 73° and supination 68°. Mean grip strength was 82% of the uninjured contralateral side. Mean DASH score and PRWE score were 10 points and 15 points, respectively. The mean pain assessed with the visual analogue scale was 2. The immediately post-operative SL gap on posterioanterior (PA) x-rays with the wrist in ulnar deviation was average 1.6 mm and at the final follow-up 1.8 mm. Three patients showed radiocarpal arthritis Grade 2 according to Knirk and Jupiter. The implant removal and rearthroscopy was performed at the average time of 1.8 years. During the rearthroscopy we could not detect any progression of SL instability from Grade 3 to Grade 4.
Grade 3 SL ligament injuries according to Geissler associated with acute DRFs treated without any surgical intervention showed no progression of SL instability to Grade 4 assessed with rearthroscopy at the time of implant removal.
