More and more children and adolescents are experiencing sports injuries only seen in adults up until now. In this report, surgeons from Children’s Hospital in Boston review the treatment of ligament tears in the wrist in children. Results of treatment usually used for adults are measured and reported.
Thirty-two children ages six to 17 were treated for painful ligament tears in the wrist. Most had a sports-related injury while playing football, hockey, or basketball. Some were involved in gymnastics, cheerleading, or rollerblading.
They followed the same treatment protocol as for an adult. Conservative care of cast immobilization followed by physical therapy. Surgery was delayed by at least six months. When pain persisted past that amount of time, then arthroscopic surgery was done.
The surgeon looked inside the wrist to assess the full extent of damage done. The main ligament involved was the scapholunate ligament. This ligament connects two of the wrist bones together (the scaphoid and the lunate). In all but one case, there was more than one ligament damaged. In many cases, two or more ligaments had been torn. In half the cases, bone damage was seen where the ligament(s) had been pulled away from the bone.
The surgeon removed any loose fragments of tissue or bone from the area and scraped away fibrous scar tissue. Tiny holes were drilled in the bone to help speed up healing. In a few cases, open surgery was needed to repair complete tears of the ligaments.
The authors report good results with this step-by-step approach to scapholunate ligament tears in young athletes. Arthroscopic exam for patients with chronic wrist pain helped isolate the problem and treat it appropriately.