Purpose of the study: The aim was to evaluate subjective and objective criteria of wrist, hand and arm function in a group of patients with acute static scapholunate dissociation treated by acute suture or ligament reinsertion, and in a group of patients with chronic static scapholunate dissociation treated by ligament reconstruction using ligamentoplasty.
Material and methods: Of a total number of 70 patients treated surgically for scapholunate instability at the Department of Trauma Surgery, University Hospital in Olomouc and the Department of Trauma Surgery, University Hospital in Brno, from 2002 till the end of 2008, 37 patients with acute or chronic static scapholunate dissociation treated by suture, ligament reinsertion or ligamentoplasty were selected. Of them, 17 patients with chronic scapholunate dissociation and 10 patients with acute scapholunate dissociation appeared at the final follow-up. The assessment of subjective criteria was based on the Disabilities of the Arm, Shoulder and Hand Score, the Wrightington Wrist Function Score and the Visual Analogue Scale. The objective criteria included range of motion and grip strength, and radiographic parameters, such as scapholunate gap and scapholunate and scaphocapitate angles. Satisfaction of the patients and their return to work were also evaluated. The results were statistically analysed using the Chi-square, Mann-Whitney-U and Wilcoxon tests, with the level of significance a=0.05.
Results: In the group with acute static scapholunate dissociation, the objective criteria showed an improved range of flexion- extension. The range of radial and ulnar bending and grip strength were almost identical with those of the healthy wrist. In both evaluated groups the self-rated criteria had almost the same values in all three rating systems used. No statistically significant difference in any of the values compared was recorded.
Discussion: The results of subjective and objective assessments were comparable in the two groups. Paradoxically, some items of the subjective evaluation were better in the patients undergoing ligament reconstruction - ligamentoplasty. This can probably be explained by different subjective comparison of pre- and post-operative conditions in each group. Even though the subjective assessment was almost identical in both groups, we definitely find an advantage in acute treatment of a scapholunate ligament tear by suture. A technically easier procedure, a shorter period of restricted hand and arm function for the patient, no degenerative changes due to instability and a lower risk of complications - they all give support to this technique. Later conversion to another type of stabilisation if ligamentoplasty fails may bring problems and give much worse results than a failure of acute sutures
Conclusions: An acute operative treatment of scapholunate ligament injury is regarded as a more suitable method for scapholunate dissociation. Ligamentoplasty, because of technical demands and risk of post-operative complications, can be used as a method of choice if the acute sutures of a torn scapholunate ligament fail or scapholunate dissociation is diagnosed at a late stage.