Carpal instability

RADIOGRAPHIC SIGNS OF STATIC CARPAL INSTABILITY WITH DISTAL END RADIUS FRACTURES: IS CURRENT TREATMENT ADEQUATE?

Hand Surgery ◽

10.1142/s0218810412500256 ◽

2012 ◽

Vol 17 (03) ◽

pp. 325-330 ◽

Cited By ~ 3

Author(s):

D. L. J. Bunker ◽

G. Pappas ◽

P. Moradi ◽

M. B. Dowd

Keyword(s):

Current Treatment ◽

Carpal Instability ◽

Radiographic Study ◽

Scapholunate Ligament ◽

Radius Fractures ◽

Distal Radial Fractures ◽

Middlesex Hospital ◽

Wrist Instability ◽

Before And After

Patients presenting with distal end radius fractures may have concomitant carpal instability due to disruption of the scapholunate ligament. This study examined the incidence of static radiographic signs of carpal instability in patients with distal radial fractures before and after fracture treatment. We performed a retrospective radiographic study of 141 patients presenting to Central Middlesex Hospital, London between January 2002–May 2004 with distal end radius fractures. We used abnormal scapholunate angle as the primary indicator of possible carpal dissociation. Abnormal scapholunate angles were noted in 39% of patients at presentation and 35% of patients after treatment with no statistically significant intra-patient variability. Persistent static radiographic signs of carpal instability are high in this subset of patients. The long-term morbidity of persistent wrist instability may be avoided by early radiological diagnosis with clinical correlation to identify carpal ligament injuries and initiate treatment that addresses both the bony and ligamentous components of the injury.

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Correction of Dorsi-Flexed Intercalated Segment Instability after Restoration of Scaphoid Height in a Cadaver Model of Scaphoid Non-Union

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(05)80117-2 ◽

1995 ◽

Vol 20 (5) ◽

pp. 596-602 ◽

Cited By ~ 9

Author(s):

M. YASUDA ◽

M. KUSUNOKI ◽

K. KAZUKI ◽

Y. YAMANO

Keyword(s):

Mechanical Loading ◽

Bone Defect ◽

Carpal Instability ◽

Rigid Fixation ◽

Anatomical Reduction ◽

Non Union ◽

Herbert Screw ◽

Palmar Approach ◽

Wrist Joints

Models of scaphoid non-union with static dorsi-flexed intercalated segment instability were produced in five frozen arms from cadavers or subjects following accidents by repetitive mechanical loading of the wrist joints longitudinally after a bone defect has been made at the mid-portion of the scaphoid. We designed four models of reduction: anatomical reduction; reduction with a shortened scaphoid; anatomical reduction but with the radio-lunate ligament sectioned, and a shortened scaphoid with the radio-lunate ligament sectioned. Results suggested that anatomical reduction with rigid fixation with a Herbert screw was most effective for correction of malalignment with DISI. Preservation of the radio-lunate ligament during the palmar approach to the scaphoid seemed to be important to prevent ligamentous carpal instability.

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