Carpal instability

The understanding of traumatic wrist instability continues to improve. Better definition of the role of ligaments, especially the interosseous ligaments, and use of computer-generated models of the wrist have shed new light on the nature of carpal kinematics. Nevertheless, a thorough patient history, a detailed physical examination, and plain radiographs remain the most important elements in the evaluation of wrist injuries. Wrist arthroscopy has supplanted most ancillary tests as the next step in diagnosis. Arthroscopy is also invaluable in the treatment of ligament injuries without significant instability. The management of static wrist instability remains challenging, and novel methods for reconstructing the scapholunate and lunotriquetral interosseous ligaments have been developed. These procedures are technically demanding, and long-term follow-up data are needed before they can become clinically useful.