Comparative Outcomes of Surgical and Nonsurgical Treatments for Scapholunate Ligament Injuries With Concomitant Distal Radius Fractures: A Systematic Review.

Abstract

Distal radius fractures (DRFs) are common, especially in elderly populations, and often occur alongside scapholunate (SL) ligament injuries (SLIs), which can progress to scapholunate advanced collapse if untreated. There is no standardized treatment for SLIs with DRFs, with options ranging from conservative management to surgical interventions. This review aims to evaluate functional, radiographic, and clinical outcomes of surgical and nonsurgical treatments for SLIs associated with DRFs. A systematic search was conducted across PubMed, ScienceDirect, and Embase according to International Prospective Register of Systematic Reviews and Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies comparing surgical and nonsurgical management in adults (≥18 years) with SLIs and DRFs were included. Outcomes assessed included Disabilities of the Arm, Shoulder, and Hand (DASH) scores, QuickDASH scores, Mayo Wrist Scores, mean grip strength, SL gap, SL angle, and wrist range of motion (ROM). Thirteen studies involving 4315 DRF patients (423 with SLIs) were analyzed. Surgical treatment showed better functional outcomes, with lower DASH scores (P = .0011) and improved radiographic alignment, indicated by lower SL angles (P = 7.5 × 10^-20). However, wrist ROM was lower in surgically treated patients, particularly in flexion (P = .00031) and extension (P = .0080). Pain was the most commonly reported complication across both groups. Surgical treatment for SLIs with DRFs may lead to functional and radiographic outcomes similar to nonsurgical options, but is associated with reduced wrist mobility. Nonsurgical management remains effective for patients with milder symptoms. Further research is necessary to refine treatment protocols and optimize outcomes for these complex injuries.