PATIENT OUTCOMES FOLLOWING REDUCTION AND ASSOCIATION OF THE SCAPHOID AND LUNATE
Bibliographic record
Abstract
Scapholunate lunate ligament (SLL) injury is the most common ligamentous injury of the wrist; however, the optimal surgical management remains unclear [1,2]. One promising technique for SLL reconstruction is the Reduction and Association of the Scaphoid and Lunate procedure (RASL), first described by Rosenwasser [3]. Despite promising preliminary outcomes by the creator [4], the outcomes of this procedure remain variable [5]. The objective of this retrospective analysis was to investigate factors affecting patient outcomes following the RASL procedure. Twenty-three patients who had a SLL tear treated with a RASL using a dual-incision approach as described by Rossenwasser [3] completed the data collection process. Participants completed a demographic survey and three standardized patient-reported outcome tools (DASH, PRWE and PROMIS questionnaires). Standard wrist radiographs were taken, and bilateral wrist range-of-motion and grip strength were measured. The scapholunate interval, scapholunate angle, radioscaphoid angle, radiolunate angle were measured preoperatively, intraoperatively, and at long-term follow up. The intraoperative images were used to assess screw placement. All measurements were taken by the primary author and independently verified by two board-certified hand surgeons. The average time since surgery was 6.3 years, with a minimum time since surgery of 2.2 years and a maximum of 11.1 years. The average age was 36.2 (SD 11) years at the time of injury. At the time of final follow-up, the average DASH score was 11.2 (SD 13). There was no correlation between DASH score and preoperative scapholunate angle (R² = 0.056), screw angle (R² = 0.061), or time from surgery (R² = 0.014). The average screw angle measured our intraoperative radiographs was 15.2° (SD 6.3°). At time of final follow-up, 4 participants had undergone a second surgery for screw removal and 1 participant was converted to a four-corner fusion for persistent pain. The average preoperative scapholunate gap was 5.0 mm in the group who had a second surgery (n =5) compared to 3.0 mm in the group with no revision surgery (n =18). The average screw angle measured our intraoperative radiographs falls below the target angle of 23°; however, we did not find a correlation between screw angle and patient-reported outcomes. Possible factors contributing to patient outcomes include severity of the injury as measured by pre-operative scapholunate gap. We conclude that patients can have exceptional outcomes following the RASL, but larger scale studies are required to identify patient and injury-related factors to select good candidates.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".