Identification and treatment of scapho-lunate injuries

Abstract

Scapholunate tears subsequent to wrist trauma may potentially created carpal instability and lead to degenerative arthritis (SLAC wrist) in the late stages. This is why it is necessary to early identify these injuries and possibly treat them in order to prevent arthritis. Arthroscopic examination of the wrist can directly visualize these injuries and then it is possible to treat them under arthroscopy or open. The Ewas classification, which is an evolution of Geissler Classification, has developed in order to define the type of injuries and to identify the site of anatomical damage, which has occurred in each patient. It also allows to choose the more appropriate treatment in each stage. Materials and methods Twenty-one patients affected by SL ligament injuries were treated and examined under arthroscopy. There were 1 stage I, 3 stage II, 4 stage IIIA, 1 stage IIIB, 7 stage IIIC, 2 stage IV and 3 stage V (static instability). Patient affected by stage I and II were treated by immobilisation alone, patients affected by stage IIIA were treated by pinning (acute and chronic), patients affected by stage IIIB and IIIC were treated by pinning in acute cases and capsulodesis (open or arthroscopic) in chronic cases. In stage IV, patients were treated by tendon reconstruction of SL ligament with a modified Brunelli technique. Patients were aged 16–57-year-old. Patients were reviewed at a mean follow-up of 3 years (6 months–9 years) and evaluated with Mayo score and Dash score. Results Twenty patients obtained an excellent or good clinical result, one fair result was obtained in a patient who had a stage 5 with initial radio-scaphoid osteoarthritis (Slac I–II). We had one case of pin-tract infection treated by oral antibiotic for 1 week. The best results were obtained in the early stages. Discussion and conclusion Early detection of SL injuries is important to prevent developement of arthritis and wrist arthroscopy is mandatory for this purpose. Ewas classification seems effective in guiding the treatment in pre-dynamic cases and dynamic cases has given excellent and good results in the great majority of cases. In later stages (static instability), Garcia-Elias criteria are of utmost importance to guide the treatment.