The edition · Orthopaedics
Late failures with the scapholunate internal brace, and why tibial slope matters most in the young
A systematic review finds the suture-tape brace for scapholunate injury poorly supported and often failing by four years, age reframes slope-driven ACL rerupture risk, and a small trial questions manual reduction of distal radius fractures.
The edition in brief
Today's orthopaedics edition. A systematic review of 11 studies and 161 wrists found little support for internal brace augmentation of scapholunate ligament repair: the two comparative studies showed no added benefit, and the one study followed beyond four years reported structural failure in 44% and perianchor osteolysis in 59%. In 581 patients after hamstring ACL reconstruction, each degree of posterior tibial slope raised rerupture odds by about 28% at any age, but the absolute risk at 15 degrees fell from about 37% at 18 to about 4% at 45. A single-centre randomised trial of 53 patients found manual reduction under haematoma block added nothing over finger-trap traction alone for displaced distal radius fractures. A Korean database study of 20,728 matched patients with Parkinson disease found a small rise in cerebrovascular events over five years after knee replacement, with no excess periprosthetic infection or fracture. The pearl covers measuring tibial slope before ACL reconstruction.
Tibial slope raised ACL rerupture risk at every age, but mattered most under 30
Combine age with tibial slope when judging ACL rerupture risk; a steep slope is a major problem in a teenager and a minor one at 45.
Manual reduction added nothing to finger-trap traction for distal radius fractures
For displaced distal radius fractures, finger-trap traction alone may be enough for the initial reduction; the bigger decision is whether to fix.
Parkinson disease brought a small rise in stroke-type events after knee replacement
Parkinson disease did not raise joint complications after knee replacement; focus perioperative attention on blood pressure, autonomic symptoms and medication timing.
Measure tibial slope before every primary ACL reconstruction
A one-minute measurement on a plain lateral radiograph can change the ACL operation you offer.
Scapholunate internal brace: weak evidence and frequent late failure
Do not use scapholunate internal brace augmentation routinely; it showed no added benefit and nearly half failed by four years in the longest study.
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