Defining DISI and VISI

Braun, Natalie S; Berger, Richard A.; Wolfe, Scott W.

doi:10.1177/1753193421989933

Cited by 16 publications

(11 citation statements)

References 10 publications

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“…165 Additionally, the variability in criteria used to define humpback deformity and DISI suggests a need for standardized criteria. This observation agrees with a recent literature review by Braun et al, 166 who argue that DISI be strictly defined as RLA > 15 degrees. Other factors, such as fracture plane, displacement, fragmentation, proximal fragment size, screw trajectory, and implant size, could not be assessed.…”

Section: Discussionsupporting

confidence: 93%

Predictors of Failure for Vascularized and Nonvascularized Bone Grafting of Scaphoid Nonunions: A Systematic Review

Rancy

Wolfe

Jerome³

2022

Journal of Hand and Microsurgery

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Objective This article compares predictors of failure for vascularized (VBG) and nonvascularized bone grafting (NVBG) of scaphoid nonunions. Methods We conducted a systematic literature review of outcomes after VBG and NVBG of scaphoid nonunion. Fifty-one VBG studies (N = 1,419 patients) and 81 NVBG studies (N = 3,019 patients) met the inclusion criteria. Data were collected on surgical technique, type of fixation, time from injury to surgery, fracture location, abnormal carpal posture (humpback deformity and/or dorsal intercalated segmental instability [DISI]), radiographic parameters of carpal alignment, prior failed surgery, smoking status, and avascular necrosis (AVN) as defined by punctate bleeding, magnetic resonance imaging (MRI) with contrast, MRI without contrast, X-ray, and histology. Meta-analysis of proportions was conducted with Freeman–Tukey double arcsine transformation. Multilevel mixed-effects analyses were performed with univariable and multivariable Poisson regression to identify confounders and evaluate predictors of failure. Results The pooled failure incidence effect size was comparable between VBG and NVBG (0.09 [95% confidence interval [CI] 0.05–0.13] and 0.08 [95% CI 0.06–0.11], respectively). Humpback deformity and/or DISI (incidence-rate radios [IRRs] 1.57, CI: 1.04–2.36) and lateral intrascaphoid angle (IRR 1.21, CI: 1.08–1.37) were significantly associated with an increased VBG failure incidence. Time from injury to surgery (IRR 1.09, CI: 1.06–1.12) and height-to-length (H/L) ratio (IRR 53.98, CI: 1.16–2,504.24) were significantly associated with an increased NVBG failure incidence, though H/L ratio demonstrated a wide CI. Decreased proximal fragment contrast uptake on MRI was a statistically significant predictor of increased failure incidence for both VBG (IRR 2.03 CI: 1.13–3.66) and NVBG (IRR 1.39, CI: 1.16–1.66). Punctate bleeding or radiographic AVN, scapholunate angle, radiolunate angle, and prior failed surgery were not associated with failure incidence for either bone graft type (p > 0.05). Conclusion Humpback deformity and/or DISI and increasing lateral intrascaphoid angle may be predictors of VBG failure. Time from injury to surgery may be a predictor of NVBG failure. AVN as defined by decreased contrast uptake on MRI may be a marker of increased failure risk for both bone graft types.

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Section: Discussionsupporting

confidence: 93%

Predictors of Failure for Vascularized and Nonvascularized Bone Grafting of Scaphoid Nonunions: A Systematic Review

Rancy

Wolfe

Jerome³

2022

Journal of Hand and Microsurgery

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“…Lunate fractures are categorized as volar pole, dorsal pole, transverse, osteochondral, and transarticular (Fig 16). Volar pole lunate fractures are the most common and are due to the axial compression from the capitate with the wrist in dorsiflexion and ulnar deviation and additionally may lead to volar intercalated segment instability (VISI) [21]. Like the scaphoid and capitate, the proximal lunate is susceptible to vascular compromise in trauma, with up to 20% of people having only a single palmar nutrient artery supplying the entire lunate.…”

Section: Carpal Fracturesmentioning

confidence: 99%

“…Dorsal intercalated segment instability (DISI) occurs when there is disruption of the SLL [21]. The "intercalated segment" can be considered a bone or series of bones fixed in a passive position between other active motion segments [4].…”

Section: Carpal Dislocationsmentioning

confidence: 99%

“…Similar to the role that disruption of the SLL plays in DISI, volar intercalated segment instability (VISI) deformity occurs when there is disruption of the lunotriquetral ligament (LTL) [21]. Because the anterior fibers of LTL are thickest, it is the main volar stabilizing element restricting the lunate from volar rotation relative to the capitate [4].…”

Section: Carpal Dislocationsmentioning

confidence: 99%

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Imaging Diagnosis and Management of Carpal Trauma and Instability – An Illustrated Guide

Okoro¹,

Skalski²,

Patel³

et al. 2023

Preprint

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Understanding the subtle signs of carpal instability and other unique injury patterns in the wrist is a critical skill for radiologists. Proper patient management and outcomes are directly dependent on the accurate interpretation of wrist imaging studies. This review will provide a detailed overview of typical imaging features of carpal trauma and instability, management, and complications, using multimodality imaging and original medical illustrations. A detailed overview of the osseous, ligamentous, arterial anatomy of the wrist, arcs of Gilula, and zones of vulnerability will be provided. Carpal fractures, dislocations, special radiographic views, and imaging pearls will be discussed. Instability patterns and the myriad of associate abbreviations (CID, CIND, CIC, CIA, VISI, DISI, SLD, LTD, MCI, SLAC, SNAC) will be clarified. Expected outcomes, potential complications, and management will be reviewed.

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“…DISI is characterized by an increased scapholunate angle > 70 degrees and an increased capitolunate angle > 20 degrees, measured on a true lateral radiograph along the long axes of these bones. 33 Open or arthroscopic debridement and primary repair may be done in acute injuries with K-wire fixation for 8 to 10 weeks. 19 Complete chronic and severe tears may require ligamentous reconstruction with various surgical techniques, such as radioscaphoid capsulodesis, the use of a bone-retinaculum-bone autograft, which could be harvested locally, or using the extrinsic dorsal intercarpal and radiocarpal or volar radioscaphocapitate ligaments.…”

Section: Fracture Fixation Of the Wrist And Handmentioning

confidence: 99%

Posttreatment Imaging of the Wrist and Hand: Update 2022

Taljanovic

Omar

Weaver

et al. 2022

Semin Musculoskelet Radiol

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Common indications for surgical procedures of the wrist and hand include acute fractures or fracture-dislocations; nonunited fractures; posttraumatic, degenerative, and inflammatory arthritides and tendinopathies; injuries to tendons, ligaments, and the triangular fibrocartilage complex; and entrapment neuropathies. Soft tissue or osseous infections or masses may also need surgical treatment. Several of these procedures require surgical hardware placement, and most entail clinical follow-up with periodic imaging. Radiography should be the first imaging modality in the evaluation of the postoperative wrist and hand. Computed tomography, magnetic resonance imaging, diagnostic ultrasonography, and occasionally nuclear medicine studies may be performed to diagnose or better characterize suspected postoperative complications. To provide adequate evaluation of postoperative imaging of the wrist and hand, the interpreting radiologist must be familiar with the basic principles of these surgical procedures and both the imaging appearance of normal postoperative findings as well as the potential complications.

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Defining DISI and VISI

Cited by 16 publications

References 10 publications

Predictors of Failure for Vascularized and Nonvascularized Bone Grafting of Scaphoid Nonunions: A Systematic Review

Predictors of Failure for Vascularized and Nonvascularized Bone Grafting of Scaphoid Nonunions: A Systematic Review

Imaging Diagnosis and Management of Carpal Trauma and Instability – An Illustrated Guide

Posttreatment Imaging of the Wrist and Hand: Update 2022

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