Scaphoid fractures and associated ligament injury : five-year follow-up of the SWIFFT trial.

Abstract

The association between scaphoid fractures and ligament injuries is uncertain, and the clinical relevance is not well established. The aim of this study was to undertake a secondary analysis of data from the Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT) to evaluate the incidence of concurrent ligament injuries in patients with a scaphoid waist fracture displaced by ≤ 2 mm, explore the radiological changes between one and five years after the injury, and assess whether there is an association between the characteristics of the fracture and ligament injury. All 439 patients from the SWIFFT had baseline measurements available from plain radiographs and CT scans. Further follow-up measurements were undertaken from CT scans in 292 patients at 52 weeks and 239 patients at five years. A total of 345 patients had radiographs suitable for assessment of the scapholunate (SL) and lunotriquetral (LT) intervals at 52 weeks and/or five years. Only 12 patients (2.8%) had widening of the SL gap by > 3 mm on initial imaging. There was no progression of these gaps at five years, and no patient had widening of the LT gap. Injury to the interosseous intercarpal ligaments causing diastasis of carpal bones is rare in patients with a scaphoid waist fracture displaced by ≤ 2 mm. Treatment of the fracture with a cast or surgical fixation, without additional imaging or intervention for a potential ligament injury, appears adequate for most fractures. If there are ligament injuries not identified with standard imaging, they do not seem to progress.