Scapholunate instability after distal radius volar plating

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Radiology

Background:

• Historically, immobilization treated incidental ligament injuries with distal radius fractures.
• Volar locked plating and early motion protocols are now standard.
• The study investigated scapholunate instability prevalence and progression in this context.

Purpose of the Study:

• Determine the prevalence of scapholunate instability.
• Identify patients with progression of occult ligament injury.
• Evaluate the impact of early motion on scapholunate instability.

Main Methods:

• Retrospective review of 221 distal radius fractures treated with volar locking plates.
• Analysis of radiographs (posteroanterior and lateral) at first and last postoperative visits.
• Scapholunate instability defined by gap ≥3 mm and angle ≥60°.

Main Results:

• 3% of patients developed instability criteria postoperatively without ligament repair.
• 3% met instability criteria at both early and late postoperative visits without repair.
• 2% underwent primary scapholunate ligament repair during fixation.

Conclusions:

• Scapholunate instability is uncommon in this patient cohort, even with early motion.
• No strong evidence supports routinely delaying motion or further workup for occult injuries.
• Aggressive treatment may be warranted for selected cases with clear early radiographic signs of instability.