- Journal
- JOURNAL OF HAND SURGERY-AMERICAN VOLUME
- Année
- 2022
- Volume
- 47
- Numéro
- 3
- Article
- 285.e1
- Mois
- MAR
- DOI
- 10.1016/j.jhsa.2021.04.024
Abstract
Purpose We report 8 cases of acute or subacute unilateral nondissociative carpal instability (CIND) in the context of nondisplaced scaphoid fractures. Methods Eight patients from 3 centers developed abnormal volar intercalated segment insta-bility (VISI) or dorsal intercalated segment instability (DISI) following the diagnosis of a nondisplaced scaphoid fracture. An operative inspection in each patient confirmed intact scapholunate and lunotriquetral interosseous ligaments. We outline the demographic char-acteristics of our patient cohort, radiologic and operative findings of CIND-DISI and CIND-VISI, and the outcomes of acute and delayed treatment. Results Two patients were diagnosed with CIND-DISI and 6 with CIND-VISI associated with ipsilateral nondisplaced scaphoid fractures. The average time from injury to diagnosis of CIND was 11 weeks, and the mean clinical and radiographic follow-up was 18 months. Rapid healing of the scaphoid fractures was achieved in all patients (4 open reduction internal fixation, 4 cast). All patients underwent surgery to improve proximal carpal row alignment: in 3 of the 4 patients who were diagnosed and treated surgically within 12 weeks of injury, the radiolunate angle (RLA) was successfully restored. A contracture release and ligament repair or reconstruction with tendon grat 12 or more weeks following injury was unsuccessful in restoring proximal row alignment in all 4 patients. Two patients in the delayed treatment group required secondary surgery for partial fusion. Conclusions Based on the arthroscopic, imaging, and operative findings, we propose that the liga-mentous restraints to CIND-VISI are dorsal at the radiocarpal joint and volar at the midcarpal joint. Conversely, the ligamentous restraints to CIND-DISI are dorsal at the midcarpal joint and volar at both the radiocarpal and midcarpal joints. In our series, a delayed diagnosis and late reconstructive surgery were associated with no improvement in RLA. We recommend early recognition of trau-matic CIND and prompt treatment of injured ligaments prior to the development of a fixed defor-mity. (J Hand Surg Am. 2022;47(3):285.e1-e11. Copyright Cl 2022 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic V.