Carpal Ligament Injuries, Pathomechanics, and Classification

Area of Science:

• Orthopedics
• Biomechanics
• Hand Surgery

Background:

• Carpal instability encompasses diverse posttraumatic and maladaptive conditions affecting wrist joint stability.
• Existing classification schemes attempt to explain the pathophysiology and progression of carpal instability.
• Common patterns include volar intercalated segment instability and dorsal intercalated segment instability.

Purpose of the Study:

• To review and synthesize current understanding of carpal instability.
• To highlight the evolution of classification systems for carpal instability.
• To discuss future directions in unifying the study of wrist instability.

Main Methods:

• Literature review of carpal instability classifications.
• Analysis of mechanistic and pathophyiological models.
• Synthesis of recent advancements in understanding carpal bone relationships.

Main Results:

• Carpal instability is characterized by the failure to maintain normal wrist anatomy under load.
• Multiple classification systems exist, with volar and dorsal intercalated segment instability being common examples.
• Recent approaches focus on inter- and intra-row carpal bone relationships.

Conclusions:

• Carpal instability is a complex condition with various etiological factors.
• Current classifications, while informative, are disparate.
• Future research aims to integrate these classifications for a unified understanding of wrist instability.