Posttraumatic Carpal Instability Nondissociative

Abstract

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.

Volar Intra-articular Extended Window Approach for Intra-articular Distal Radius Fractures

“…The presence of radiocarpal instability in conjunction with a distal radius fracture is possible but rare; however, it should always be considered. [28][29][30]…”

“…The main contraindication to this approach is in cases with prior or concomitant non-dissociative radiocarpal instability, as volar extrinsic ligament release during the approach could exacerbate any degree of preoperative instability. The presence of radiocarpal instability in conjunction with a distal radius fracture is possible but rare; however, it should always be considered 28–30 …”