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Metacarpal Small Incision for Carpal Tunnel Syndrome
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Published on: April 5, 2024

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Traumatic Nondissociative Carpal Instability: A Case Series.

Francois Loisel1, Steven Orr2, Mark Ross3

  • 1Besançon Teaching Hospital, Besançon, France.

The Journal of Hand Surgery
|June 28, 2021
PubMed
Summary

Nondisplaced scaphoid fractures can cause carpal instability, leading to volar intercalated segment instability (VISI) or dorsal intercalated segment instability (DISI). Early treatment of injured ligaments is crucial for restoring wrist alignment and function.

Keywords:
Carpal instability nondissociativecarpal ligament injurydorsal intercalated segment instabilityscaphoid fracturevolar intercalated segment instability

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Area of Science:

  • Orthopedic Surgery
  • Hand and Wrist Surgery
  • Musculoskeletal Imaging

Background:

  • Nondisplaced scaphoid fractures can present with associated carpal instability.
  • Acute or subacute unilateral nondissociative carpal instability (CIND) is a rare complication.
  • Understanding the ligamentous restraints is key to effective treatment.

Purpose of the Study:

  • To report 8 cases of CIND associated with nondisplaced scaphoid fractures.
  • To characterize the demographic, radiologic, and operative findings of CIND.
  • To evaluate the outcomes of acute versus delayed treatment for CIND.

Main Methods:

  • Retrospective case series of 8 patients from 3 centers.
  • Diagnosis of CIND-VISI or CIND-DISI based on clinical and radiologic findings.
  • Surgical exploration to confirm ligament integrity and assess carpal alignment.

Main Results:

  • Two patients had CIND-DISI, and 6 had CIND-VISI with nondisplaced scaphoid fractures.
  • Average time to CIND diagnosis was 11 weeks; average follow-up was 18 months.
  • Early surgical treatment (within 12 weeks) successfully restored radiolunate angle (RLA) in 3/4 patients; delayed treatment was unsuccessful.

Conclusions:

  • Ligamentous restraints for CIND-VISI and CIND-DISI involve specific radiocarpal and midcarpal articulations.
  • Delayed diagnosis and treatment of CIND are associated with poor outcomes in restoring RLA.
  • Early recognition and prompt surgical intervention for traumatic CIND are recommended to prevent fixed deformity.