The clinical outcome after extra-articular colles fractures with simultaneous moderate scapholunate dissociation.

Abstract

Background An increased scapholunate gap is sometimes seen in patients with a distal radial fracture. The question remains as to whether this represents a scapholunate ligament injury that requires treatment. Questions/purposes We wished to examine the natural history of an increased scapholunate gap in patients following an extra-articular distal radial fracture. Patients and Methods We reviewed 260 patients who had sustained a distal radial fracture at a mean of 6.2 (2.7-11.9) years previously and identified 12 extra-articular fractures with an increased gap between the lunate and scaphoid. The mean scapholunate gap was 2.6 (2.1-3.4) mm, and the mean scapholunate angle 62° (39°-90°). Controls were found among the remaining patients with extra-articular fractures. Selection criteria were same sex, age at fracture within 5 years, time between injury and review within 2 years, ulnar variance within 2 mm, and dorsal angulation within 5° of index patient. When more than one control fulfilled the criteria for an index patient, their values were averaged. In total there were 54 controls for the 12 index patients. Results The mean difference between index patients and controls in wrist range of motion was 4%, in grip strength 5%, in visual analog scale (VAS) for pain 1 (on a scale from 1 to 100), in Quick-DASH (Disability of the Arm, Shoulder, and Hand) score 5, and in PRWE score 1. The study was calculated to have the power to detect a difference in Quick-DASH scores and in Patient-Rated Wrist Evaluation (PRWE) scores of 14. Conclusions We conclude that at a mean follow up of 6.2 years following an extra-articular distal radial fracture, no surgical treatment is usually needed with a scapholunate gap of between 2.1-3.4 mm. Level of Evidence III, Case control study.