Impact of Unrepaired Scapholunate Ligament Injury Following Intra-articular Distal Radius Fractures on Patient Outcomes
Kevin M. Klifto, PharmD1, Christopher S. Klifto, MD2, Rachel E. Hein, MD2, David S. Ruch, MD2.
1University of Pennsylvania, Moorestown, NJ, USA, 2Duke University, Durham, NC, USA.
BACKGROUND: The purpose of this study was to evaluate a series of intra-articular distal radius fracture (DRF) to determine if patients without radiographically evident scapholunate ligament injury (SLI) have a difference in outcomes in comparison to patients with unrepaired radiographically evident SLI. Our hypothesis is that there are no significant differences in long-term outcomes between patients after treatment of their intra-articular DRF.
METHODS: An IRB-approved, retrospective analysis of patients from a single institution who sustained an intra-articular DRF from January 2006 through January 2019 was performed. Patient demographic, clinical and outcome variables were compared between scapholunate (SL) angles <70° (cohort one) and SL angles ≥70° (cohort two). Radiographic parameters were measured and recorded at three time points: baseline in the contralateral wrist, following closed reduction but prior to surgical intervention, and at final follow-up. Minimum follow-up for patients was 12 months. Outcomes scores collected include Quick Disabilities of the Arm Shoulder and Hand (qDASH), Modified Global Assessment of Function (mGAF) and visual analogue scale (VAS) for pain. These two cohorts were analyzed using univariate analyses, followed by a post-hoc power analysis.
RESULTS: One hundred and ninety-two patients were included. Of these 192 patients, the first cohort (n=110) measured median (range) SL angles of 58° (42-68°) and the second cohort (n=82) measured median (range) SL angles of 74.5° (70-87°) after closed reduction. Cohort two had statistically significant increases in median SL angles from closed reduction to final follow-up [74.5° (range: 70-87°) to 78.5° (range: 71-107°), p<0.001. There were no statistically significant differences in qDASH disability scores, mGAF scores, and VAS pain scores between the two cohorts at initial and final follow-ups.
CONCLUSIONS: Patient reported outcomes do not differ between patients without radiographically apparent SLI and patients with radiographically apparent SLI and no ligament repair or reconstruction following intra-articular DRF at 12 months and 24 months.
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