Is There a Difference in Effectiveness Between Nonoperative Treatments for Modified Garcia-Elias Scapholunate Ligament Injuries Stages 1 and 2?

Abstract

Introduction Scapholunate interosseous ligament (SLIL) injuries result from falling on an outstretched hand. Studies have assessed the effectiveness of non-operative treatments, but none has compared different non-operative treatments. We analyze the effectiveness of casting and bracing/splinting based on patient reported outcomes (PRO). Methods Chart review was conducted on 1150 possible SLIL injury patients from 5 orthopaedic hand surgeons from a Midwestern, tertiary-care academic hospital system between 2021 and 2024. Two patient cohorts were divided based on treatment. PROs obtained were PROMIS Upper Extremity (UE) and Pain Interference (PI) pre-treatment and 2-3 months after. Patient improvement was calculated as difference between post- and pre-treatment PROMIS scores, with positive change in UE and negative change in PI indicating improvement. Statistical analysis was performed using paired t-tests comparing patient improvement between the two cohorts. Results 17 bracing/splinting and 15 casting patients met our inclusion criteria. Bracing/splinting PROMIS UE pre- and post-treatment differences is a mean of 3.47 (SD = 6.84) while casting average difference is 7 (SD = 13.01). Bracing/splinting PROMIS PI pre- and post-treatment differences is a mean of -4.82 (SD = 6.98) while casting average difference is -3.53 (SD = 10.03). PROMIS UE and PI comparisons yielded no significant differences (p = 0.34, p = 0.67, respectively). Conclusion Preliminary PROMIS results yielded no significant differences in the two treatments methods, suggesting nonoperative casting and bracing/splinting are all equally effective. Further analysis with a larger population is needed to confirm these findings and whether similar trends can be found with long-term SLIL outcomes