Scapholunate internal brace: weak evidence and frequent late failure

Design

Systematic review with narrative synthesis (no meta-analysis)

Population

11 studies, 161 wrists with scapholunate interosseous ligament injury

Primary outcome

Pain, function, radiographic correction, osteolysis and structural failure

Effect

No added benefit in 2 comparative studies; structural failure 44% and osteolysis 59% at 50 months (n = 18)

This systematic review gathered 11 studies of internal brace augmentation, using synthetic suture tape and anchors, for scapholunate ligament injury: 161 wrists, follow-up of 12 to 50 months. Only two studies had a comparison group, and the quality of most was low.

In the two comparative studies, adding the brace did not improve pain, function or disability over repair or reconstruction without it. The single-arm series reported improvement, but without controls. The only study followed beyond four years found structural failure, loss of reduction or rupture, in 44% of 18 wrists, and perianchor osteolysis in 59%. One comparative study found osteolysis in 36% with the brace and none in the comparison group.

The brace was adopted largely on biomechanical promise and early pain relief. This review suggests that early improvement hides late failure, and that most studies stopped too soon to see it.

Until prospective studies with at least five years of radiographic follow-up exist, the technique should not be routine. Patients who have had it deserve periodic radiographs, and those considering it should be told about the risk of late failure and bone loss around the anchors.

• Avoid routine internal brace augmentation for scapholunate injury until longer-term data exist.
• Tell patients considering it about late structural failure and anchor osteolysis.
• Arrange periodic radiographs for patients who already have the construct.
• Look for widening of the scapholunate gap and lucency around anchors on follow-up films.
• Prefer techniques with longer follow-up data when choosing a reconstruction.

Why it matters

It is a reminder that an implant's early results can hide late failure for years.

Don't overread it

Low-quality studies on both sides; the review shows the benefit is unproven, not that the brace always fails.

The statistics, in plain English

The 44% failure rate comes from 18 wrists, so the true rate could be well above or below that. No meta-analysis was done because the studies were too different, which is itself a sign of weak evidence.

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