J Wrist Surg 2021; 10(04): 290-295
DOI: 10.1055/s-0041-1723794
Scientific Article

Posttraumatic Carpal Instability Nondissociative

Lukas Urbanschitz
1   Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
,
Tatjana Pastor
1   Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
,
Benjamin Fritz
2   Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
,
Andreas Schweizer
1   Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
,
Lisa Reissner
1   Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
› Author Affiliations
Funding None.

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.

Ethical Approval

The local ethics committee approved the study: BASEC-Nr. 2018–00981.




Publication History

Received: 17 July 2020

Accepted: 29 December 2020

Article published online:
09 February 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
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