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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

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