Article
A new entity of carpal instability non dissociative after wrist fractures
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Authors
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Margaret Fok
- Department of O & T, Queen Mary Hospital, Hong Kong, Hong Kong
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Diego Fernandez
- University of Bern, Bern, Switzerland
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation: Adaptive carpal instability following mal-united extra-articular Colles' fracture is a well-recognized condition. Yet carpal instability non-dissociative (CIND) after intra-articular distal radius fractures or radiocarpal dislocation has not been reported. This study aims to report this new entity.
Methods: 12 patients with an average age of 32 years old were identified with CIND, 9 after intra-articular fractures and 3 after radiocarpal fracture-dislocations between 2013 and 2018. Ten patients exhibited CIND- volar intercalated segmental instability (VISI) radiographically at different post-operative periods, while 2 patients exhibited CIND- dorsal intercalated segmental instability (DISI) already present at initial post-operative x rays.
In cadaveric dissections, CIND-VISI displacement could be reproduced by applying an axial loading and dorsal shearing force on a wrist with sectioned short radiolunate ligament and dorsal radiotriquetral ligament. For the intra-articular fractures with CIND- DISI malalignment the cause is most likely a result of a volar radiocarpal extrinsic ligament injury combined with intra-articular incongruity of the scaphoid fossa.
Results and Conclusions: Eight out of 12 patients with severe wrist pain underwent additional surgery. Three patients with reducible CIND-VISI had open capsular repair and temporary radiocarpal trans-fixation while 5 patients with fixed non-reducible malalignment were treated with radioscapholunate arthrodesis. At an average follow up of 2.3 years, pain relieved was noted, together with an improvement in the grip strength and a functional range of movement of the wrist. Radiographically the wrist alignment was corrected and maintained in the 8 patients. No surgical complications were observed.
This article describes a new CIND entity that may present after acute wrist injuries. Most of the patients are young and are involved in high energy trauma. High index of suspicion is warranted in patients presented with stiffness at the sub-acute period. Early detection of the malalignment can preserve the joint mobility by capsular repair. In cases with fixed deformity, a limited radiocarpal fusion is recommended for treatment.
