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Post-traumatic irreducible nondissociative carpal instability: a case report
D M Arms1, R A Martin, W B Strecker
1Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
The Journal of Hand Surgery
|September 1, 1995
Summary
This case report details the first documented instance of post-traumatic volar intercalated carpal instability caused by a wrist flexion force and dorsal capsuloligamentous tear, alongside carpal bone coalition. Surgical repair yielded excellent results.
Area of Science:
- Orthopedics
- Hand Surgery
- Traumatology
Background:
- Volar intercalated carpal instability (VICI) is a complex wrist condition often resulting from ligamentous injury.
- Irreducible VICI, particularly nondissociative types, presents unique diagnostic and therapeutic challenges.
- Carpal bone coalitions, or synostosis/synfibrosis, can affect carpal mechanics and stability.
Observation:
- A rare case of post-traumatic, irreducible nondissociative VICI is presented, linked to a specific wrist flexion injury and dorsal capsuloligamentous tear.
- The affected wrist also exhibited bilateral intraosseous coalitions within the proximal carpal row: scapholunate synfibrosis and lunotriquetral synostosis.
- This dual pathology represents a unique combination of instability and carpal fusion.
Findings:
- Surgical intervention involved open removal of an interposed capsuloligamentous flap within the radiocarpal joint.
- Carpal elements were realigned, temporarily fixated internally, and the dorsal capsule and ligaments were repaired.
- The treatment approach resulted in an excellent clinical outcome for the patient.
Implications:
- This case expands the understanding of VICI etiology, highlighting unusual injury mechanisms and concurrent carpal pathologies.
- It underscores the importance of thorough diagnostic evaluation in complex wrist trauma to identify all contributing factors.
- The successful surgical management demonstrates a viable treatment strategy for this specific, complex presentation of VICI and carpal coalition.