Is the Repair of Acute Scapholunate Injuries Associated With Distal Radius Fractures Necessary at the Time of Osteosynthesis? A Systematic Review and Meta-Analysis

Abstract

Background: Acute scapholunate ligament injuries (SLIs) can occur in distal radial fractures (DRFs). This systematic review compares patient-reported outcomes and range of motion (ROM) between operative and nonoperative treatment of acute SLIs in association with surgical fixation of DRFs. We hypothesize that there is no clinical difference.

Methods: A meta-analysis was used to evaluate the effectiveness of SLI repair versus no repair occurring with DRF with Disabilities of the Arm, Shoulder, and Hand (DASH) scores. We identified 154 articles of which 14 were eligible for review. Only 7 studies reported sufficient radiographic or clinical outcomes data and were included: 3 for meta-analysis and 4 underwent narrative analysis due to lack of homogeneity. We analyzed the patients in 2 groups: operative SLI (O-SLI) versus nonoperative SLI (NO-SLI). The primary outcomes were ROM and DASH scores with 1-year follow-up, where a pooled effect size was generated to determine a difference between groups.

Results: A total of 128 patients were included (71 O-SLI and 57 NO-SLI), with a mean follow-up of 70.2 months (SD: 23.5). The overall effect size for ROM for flexion was 1.74 (95% confidence interval [CI], -3.48 to 6.95; P = .51) and for extension was 0.79 (95% CI, -3.41 to 4.99; P = .71), while the overall effect size for DASH scores was -0.28 (95% CI, -0.66 to 0.10; P = .14). Although NO-SLI led to better ROM and O-SLI led to lower DASH scores, these were not significantly different.

Conclusion: The acute surgical intervention of a scapholunate interosseous ligament injury is no different from conservative management in the setting of acute DRFs undergoing osteosynthesis. But the sample size for pooed analyses was small, hence the evidence to date is low to recommend either way.

Keywords: SLAC; arthroscopy; distal radial fracture; internal fixation; scapholunate; volar plate.

Figure 1.

Flowchart of literature, resulting in 7 eligible studies for analysis. Note. DRF = distal radial fracture; ORIF = open reduction internal fixation.

Figure 2.

Forest plot and meta-analysis results comparing range of motion (ROM)-flexion, ROM-extension, and DASH scores between operative and nonoperative treatment for scapholunate injury. Note. In the x-axis, Hedges’ g value for each study and the overall effect: 0, no effect; toward −1, favors O-SLI; toward +1, favors NO-SLI. DASH = Disabilities of the Arm, Shoulder, and Hand; O-SLI = operative scapholunate ligament injury; NO-SLI = nonoperative scapholunate ligament injury; CI = confidence interval; REML = restricted maximum likelihood.