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Posttraumatic Carpal Instability Nondissociative.

Lukas Urbanschitz1, Tatjana Pastor1, Benjamin Fritz2

  • 1Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland.

Journal of Wrist Surgery
|August 12, 2021
PubMed
Summary
This summary is machine-generated.

Posttraumatic midcarpal instability nondissociative (CIND) treatment varies by type. Conservative care is effective for some CIND-VISI cases, while CIND-DISI generally requires surgical intervention for optimal outcomes.

Keywords:
CINDcarpal instability nondissociativecarpal malalignmentintercalated segment instabilityligament lesions

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Area of Science:

  • Orthopedic Surgery
  • Musculoskeletal Imaging
  • Wrist Biomechanics

Background:

  • Posttraumatic midcarpal instability nondissociative (CIND) is a rare condition with unknown treatment outcomes.
  • Understanding CIND, including its dorsal intercalated segment instability (CIND-DISI) and volar intercalated segment instability (CIND-VISI) patterns, is crucial for effective management.

Purpose of the Study:

  • To investigate diverse treatment options for posttraumatic CIND.
  • To describe radiological and MRI findings in patients with CIND.

Main Methods:

  • Retrospective analysis of 10 patients with CIND following acute wrist trauma (2007-2018).
  • Classification into CIND-DISI (3 patients) and CIND-VISI (7 patients) based on radiographic patterns.
  • Evaluation of treatment outcomes, including conservative management, proximal row carpectomy (PRC), radiolunate fusion, and total wrist fusion.

Main Results:

  • Three CIND-VISI patients achieved satisfactory outcomes with conservative treatment.
  • Surgical intervention was necessary for all CIND-DISI patients and three CIND-VISI patients.
  • MRI revealed radiolunate ligament rupture in all CIND-DISI cases; no ligament injury was observed in four CIND-VISI patients.

Conclusions:

  • Conservative therapy is a viable first step for CIND-VISI, particularly when no ligament injury is evident.
  • Surgical management, including ligament suture, radiolunate fusion, PRC, or total wrist fusion, is recommended for CIND-DISI.
  • This study provides initial insights into the pathology and treatment of rare CIND.