Biomechanical Analysis of Palmar Midcarpal Instability and Treatment by Partial Wrist Arthrodesis

Shiga, Sarah; Werner, Frederick W.; García-Elias, Marc; Harley, Brian J.

doi:10.1016/j.jhsa.2017.10.012

Cited by 6 publications

(11 citation statements)

References 18 publications

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“…Goldfarb et al 16 reported that 7 of 8 patients were satisfied with 4-corner fusion and 6 of them had no pain or mild pain after surgery, compared with Rao and Culver, 17 who found only half of 10 patients had good or excellent result after triquetrohamate fusion. Shiga et al 18 analyzed palmar midcarpal instability and treatment by simulated triquetrohamate and radiolunate fusion in nine cadavers. They concluded, that Fig.…”

Section: Discussionmentioning

confidence: 99%

Posttraumatic Carpal Instability Nondissociative

et al. 2021

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Background Posttraumatic midcarpal instability nondissociative (CIND) is an exceptional rare condition, therefore the outcome after different treatment options remains unknown. Questions The purpose of this study was to investigate the different treatment options for posttraumatic CIND. We also describe the different radiological and magnetic resonance imaging (MRI) findings in this patient cohort. Patients and Methods We present outcomes of 10 patients who developed CIND following acute wrist trauma between 2007 and 2018, 3 with dorsal intercalated segment instability pattern (CIND-DISI) and 7 with volar intercalated segment instability (CIND-VISI) radiographically. Results Three patients with CIND-VISI had satisfactory outcomes with conservative treatment. Two patients with irreducible CIND-DISI and one with CIND-VISI underwent proximal row carpectomy (PRC), two with reducible CIND-VISI had radiolunate fusion, and two with secondary osteoarthritis had total wrist fusion. All patients with CIND-DISI needed surgery, whereas only four of the seven patients with CIND-VISI needed surgery. On MRI, all three patients with CIND-DISI had rupture of the radiolunate ligament. Conclusions The data collected in this study may provide the first step toward better understanding of the pathology for this exceptionally rare finding. In CIND-VISI, we have not seen any ligament injury in four patients. Therefore, conservative therapy is more likely to be the first step. In CIND-DISI, we recommend an operative procedure: if detected early, with ligament suture, otherwise by radiolunate fusion, PRC, or total wrist fusion. Level of Evidence This is a Level IV study.

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Section: Discussionmentioning

confidence: 99%

Posttraumatic Carpal Instability Nondissociative

et al. 2021

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“…This is complicated by the use of confusing nomenclatures and a sparsity of high-level evidence. 18 Most reports are based on small retrospective case series with a short follow-up and a lack of diagnosis and severity of the type of MCI being treated. Definitions of outcomes also varied.…”

Section: Discussionmentioning

confidence: 99%

“…This supports the hypothesis by Lichtman et al that TH fusion can lead to a compensatory hypermobility on the radial midcarpal joint. 8,18 Four-corner fusion appears to have the best result. 45 In the series by Goldfarb et al, among eight patients with an average follow-up of 34 months, the majority were satisfied with surgery.…”

Section: Bone Proceduresmentioning

confidence: 97%

“…Shiga et al replicated PMCI on nine cadavers and simulated TH and RL arthrodesis. 18 The authors found that although both fusions had eliminated the catchup clunk, TH fusion altered the proximal row's motion (increased scaphoid flexion and reduced extension during radioulnar deviation), while RL fusion reduced it. This supports the hypothesis by Lichtman et al that TH fusion can lead to a compensatory hypermobility on the radial midcarpal joint.…”

Section: Bone Proceduresmentioning

confidence: 99%

“…7,14,15 Others have also implicated damage to additional ligaments on the radial side of midcarpal joint in some subtypes of PMCI to occur. 4,[16][17][18] These include the STT and scaphocapitate ligaments, which separates the proximal and distal row further. This allows the scaphoid to flex, hinging on the intact radioscaphocapitate ligament, taking the proximal row with it.…”

Section: Pathophysiologymentioning

confidence: 99%

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Demystifying Palmar Midcarpal Instability

2020

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Palmar midcarpal instability is an uncommon condition diagnosed clinically with a painful pathognomonic clunk on terminal ulnar deviation of the wrist. Various causes have been described, but congenital laxity of the carpal ligaments is thought to be a key contributor. Treatment commences with conservative measures. This includes proprioceptive training based on more recent concepts on the sensorimotor function of the wrist. When these measures plateau, surgery is considered. The lack of high-level evidence and consensus on its cause continue to hamper our understanding and knowledge of this condition. The purpose of this review is to examine the current evidence to conceptualize this mysterious, yet infrequent phenomenon, and to provide an algorithm on its management.

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Dynamic MRI of the wrist in less than 20 seconds: normal midcarpal motion and reader reliability

et al. 2019

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OBJECTIVE-To describe the normal motion pattern at the midcarpal compartment during active radial-ulnar deviation of the wrist using dynamic MRI and to determine the observer performance for measurements obtained in asymptomatic volunteers.METHODS-Dynamic MRI of 35 wrists in 19 asymptomatic volunteers (age mean 30.4 yrs, sd 8.6) was performed during active radial-ulnar deviation using a fast gradient-echo pulse sequence with 315 ms temporal resolution (acquisition time, 19 sec). Two independent readers measured the transverse translation of the trapezium at the scaphotrapezium joint (STJ) and the capitate-to-Terms of use and reuse: academic research for non-commercial purposes, see here for full terms. http://www.springer.com/gb/openaccess/authors-rights/aam-terms-v1

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Biomechanical Analysis of Palmar Midcarpal Instability and Treatment by Partial Wrist Arthrodesis

Cited by 6 publications

References 18 publications

Posttraumatic Carpal Instability Nondissociative

Posttraumatic Carpal Instability Nondissociative

Demystifying Palmar Midcarpal Instability

Dynamic MRI of the wrist in less than 20 seconds: normal midcarpal motion and reader reliability

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