Injuries of the Scapholunate Ligament in Children

Author(s): Alt V, Gasnier J, Sicre G

Source: J Pediatr Orthop 13:326-329, 2004

Summary:

Lesions of the scaphoid ligament are uncommon in children.  Only a few published series have been reported.  This paper describes three children with scaphoid ligament injuries diagnosed by arthroscopy and treated with open repair.  All children sustained injuries to their wrist with or without concomitant radius fracture. The initial diagnosis of scapholunate ligament injury was based primarily on the physical examination.  A positive scaphoid shift test was present in each patient, which warranted further evaluation.  The radiographs were unremarkable in two patients without appreciable separation between the scaphoid and lunate.  The unossified scaphoid made diagnosis especially difficult. Arthroscopy revealed complete disruption in all patients with two injuries being “intraligamentous” and one injury where the ligament failed at its insertion on the scaphoid.  Open repair resulted in restoration of scaphoid ligament stability with a negative scaphoid shift test and good clinical outcome.  Radiographs did not demonstrate persistent scapholunate ligament instability.

This paper emphasizes the necessity of careful clinical examination in children with suspected scapholunate ligament injuries.  While rare, a persistent scaphoid shift test with or without scapholunate ligament tenderness warrants further evaluation.  Anatomic restoration is recommended and was performed in these three children.  Interestingly, the results in children, at least in these three cases, appear to be superior to those obtained in adults.

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