Comparative Effectiveness of Nonsurgical Treatments for Modified Garcia-Elias Stage 1 and 2 Scapholunate Ligament Injuries

Purpose The scapholunate interosseous ligament (SLIL) is the most injured ligament in the wrist. Although nonsurgical treatments for early-stage SLIL injuries have been discussed, no studies have directly compared the effectiveness of these treatments. This study examines the effectiveness of casting versus bracing/splinting using patient-reported outcomes as a measure of outcomes. Methods Retrospective chart review was conducted on 3,732 patients with potential SLIL injuries from five orthopedic hand surgeons at a Midwestern, tertiary care academic health system between 2021 and 2025. Patients were divided into two cohorts by treatment type and assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) and Pain Interference (PI) surveys pretreatment and 6–8 weeks after. Statistical analysis was performed using Kruskal–Wallis tests for numeric variables comparing patient improvement between the two cohorts. Results In total, 23 bracing/splinting and 27 casting patients were included in the final analysis. The median difference of PROMIS UE in bracing/splinting cohort was 3.0 (IQR, 1.0 to 8.0) and 1.5 (IQR, –5.0 to 7.0) in casting, with positive change indicating symptom improvement. Bracing/splinting PROMIS PI pre- and post-treatment differences was a median of –6.0 (IQR, –8.0 to –0.0), whereas casting was –2.0 (IQR, –8.0 to 3.0), with negative change indicating symptom improvement. PROMIS UE and PI comparisons yielded no significant differences ( P = .265, P = .207, respectively). Conclusions Results showed no significant differences between bracing/splinting and casting treatments for Stage 1 and 2 SLIL injuries, suggesting similar effectiveness. However, further analysis with a larger sample size and randomizations is required to confirm these findings and determine if similar trends are sustained in long-term SLIL outcomes. Gaining insight into the management of nonspecific traumatic wrist injuries with no radiographic abnormalities offers patients a range of nonsurgical treatment options, allowing them to choose based on factors such as convenience, quality of life, and comfort. Type of study/level of evidence Therapeutic III.