The use of temporary screw augmentation for the treatment of scapholunate injuries.
BACKGROUND
Injuries to the scapholunate (SL) interosseous ligament can have devastating consequences to carpal stability. The purpose of this study is to provide a technique for screw augmentation to SL reconstruction, while comparing radiographic outcomes to a traditional Kirschner wire fixation cohort.


METHODS
A retrospective review of all patients treated by screw fixation for SL ligament injuries was cross-matched to a cohort of patients treated with pin fixation for age and length of time from the time of injury to surgical fixation. Outcomes were the values of SL gap and SL angle on plain radiographs as averaged between 2 independent reviewers, as well as complications.


RESULTS
Seven patients who received screw augmentation had an average follow-up of 8.7 months. When compared with the Kirschner wire cohort, there was improvement of immediate postoperative gap in the screw cohort of 3.1 versus 1.3 mm. There was also better reduction in SL angle in the screw group (22 vs. 10.4 degrees correction). At 4 months follow-up, both the SL gap and SL angle were maintained better in the screw group. There was 1 infection in each cohort, 1 pin migration in a screw/pin combination patient counted in the screw group, and 1 pin migration in the pin cohort.


CONCLUSIONS
Our study suggests that temporary screw augmentation for SL ligament injuries results in more effective SL gap and SL angle correction both immediately and in short-term follow-up than does pin fixation. Longer follow-up is needed to evaluate longevity of reduction, and larger, prospective studies with clinical outcomes are needed to show statistically significant benefits to screw augmentation.
Carolinas Medical Center †OrthoCarolina, Charlotte, NC, USA.
Timothy Brad
TB
Larson
Raymond Glenn
RG
Gaston
Robert Christopher
RC
Chadderdon
D000328:Adult; D000368:Aged; D001863:Bone Screws; D001864:Bone Wires; D050824:Carpal Joints / Q000293:injuries / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery*; D012667:Lunate Bone / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011379:Prognosis; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D021361:Scaphoid Bone / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult