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Carpal instability

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By Rajesh Purushothaman Additional Professor of Orthopaedics, Government Medical College, Kozhikode, Kerala, India
John T Capo, Sandro J Corti, Ben Shamian, Ali Nourbakhsh, Virak Tan, Neil Kaushal, Monika Debkowska
BACKGROUND: The aims of this study were to evaluate the associated injuries occurring with acute perilunate instability and to assess the clinical and radiographic outcomes of perilunate dislocations and fracture-dislocations treated with a combined dorsal and volar approach. METHODS: A total of 45 patients (46 wrist injuries) with perilunate dislocations and fracture-dislocations were prospectively evaluated. The size of the mid-carpal ligament tear, the location of the scapholunate ligament tear, and the presence of osteochondral fragments and of the dorsal radiocarpal ligament avulsions were recorded at injury...
December 2012: Hand: Official Journal of the American Association for Hand Surgery
Melissa A Klausmeyer, Diego L Fernandez, Martin Caloia
Long-standing scaphoid nonunion, scaphoid malunion, and chronic scapholunate dissociation result in malalignment of the carpal bones, progressive carpal collapse, instability, and osteoarthritis of the wrist. The most commonly used procedures to treat scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC) wrists are the four-corner fusion (4CF) and the proximal row carpectomy (PRC). The purpose of this study was to evaluate the clinical outcome of a different treatment modality: radial styloidectomy and scaphocapitolunate (SCL) arthrodesis...
August 2012: Journal of Wrist Surgery
Davood Jafari, Hamid Taheri, Hooman Shariatzade, Farid Najd Mazhar, Alireza Jalili, Mohamad Ghahramani
BACKGROUND: Radiography is the most widely available imaging modality. Precise evaluations of wrist x-ray can help diagnosis and evaluate the prognosis of many wrist disorders. METHODS: We measured length, angles and indices in 150 posteroanterior and lateral wrist x-rays to determine normal dimensions and variations according to age and sex. All x-rays were made with standard exposure, with the wrist and forearm in a neutral position. RESULTS: The average carpal height ratio was 0...
August 2012: Medical Journal of the Islamic Republic of Iran
Bhavuk Garg, Tarun Goyal, Prakash P Kotwal
Carpal injuries are frequently underdiagnosed and underreported injuries of the hand. Scapholunate perilunate dissociation is the most common perilunate instability pattern seen in clinical practice. Transscaphoid, transtriquetral, transcapitate dislocation with a volar intercalated segment instability pattern is a very rare pattern of carpal injury. We describe a case with this unique pattern of injury, explaining its mechanism and treatment. Good outcome can be achieved in these injuries following open reduction and internal fixation with ligamentous repair...
September 2013: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
Stephen A Kennedy, Christopher H Allan
No abstract text is available yet for this article.
April 2012: Clinical Orthopaedics and related Research
Martín Caloia, Hugo Caloia, Enrique Pereira
BACKGROUND: Irreparable tears to the scapholunate (SL) interosseous ligament area are common causes of mechanical wrist pain and yet treatment of this condition remains challenging. The reduction association of the SL joint (RASL) technique alleviates pain while preserving wrist function by creating a fibrous pseudarthrosis stabilized by a cannulated screw placed through the SL joint. Although arthroscopic RASL (ARASL) is a minimally invasive alternative to the open procedure, its effectiveness in controlling pain and preserving wrist function has not been established...
April 2012: Clinical Orthopaedics and related Research
J Laulan, G Bacle, C de Bodman, N Najihi, J Richou, E Simon, Y Saint-Cast, L Obert, A Saraux, P Bellemère, T Dréano, M Le Bourg, D Le Nen
For the patient (and the surgeon) the ideal wrist is one that has good mobility, however very often the optimal surgical treatment is one that provides effective pain relief. The patient must be informed of the potential complications and limitations of each procedure. The patient's psychological profile and functional requirements will determine how well he/she adapts to the changes. Also, each surgeon has beliefs and personal experiences that influence the treatment decision and final result. Proximal row carpectomy (PRC) and the Watson procedure are two reference operations for osteoarthritis secondary to scapholunate instability and scaphoid non-union (SLAC and SNAC)...
June 2011: Orthopaedics & Traumatology, Surgery & Research: OTSR
Daniel Avrahami
Wrist injuries and carpal instability may result from various sport-related acitivites. Lunotriquetral instability (LTI) is an infrequently recognized cause of wrist pain in athletes. The diagnosis of LTI through history and physical examination can be confirmed by Magnetic Resonance Arthrogram (MRA). This case report describes a case of clinically suspected LTI confirmed by MRA. Relevant literature on lunotriquetral injuries is discussed. Lunotriquetral joint injury can present itself and should be considered within a differential diagnosis of a wrist injury...
December 2010: Journal of the Canadian Chiropractic Association
Ben Bedford, S Steven Yang
BACKGROUND: Scaphoid excision and four-corner fusion is commonly performed to reconstruct advanced scapholunate collapse and scaphoid nonunion with collapse. Metallic plates were introduced for achieving fixation of the four carpal bones. Although the developer reported high rates of fusion, several other early reports of circular plate fixation suggest higher complication rates and inferior outcomes compared with traditional fixation techniques. QUESTIONS/PURPOSES: To clarify the controversy in the literature we determined the fusion rates, complications, and functional outcomes of patients having circular plate fixation for four-corner fusion...
January 2010: Clinical Orthopaedics and related Research
B T Carlsen, A Y Shin
The topic of wrist or carpal instability has been a source of confusion and miscommunication for decades. The terminology can often be difficult to understand and one surgeon's concept of instability may be completely different from another's. This is by no means a comprehensive review of carpal instability, which has often been the focus of numerous multi-volume textbooks. The purpose of this paper is to detail the basics of carpal instability, the anatomy, pathomechanics, terminology and basic principles of treatment...
2008: Scandinavian Journal of Surgery: SJS
Alejandro Badia, Prakash Khanchandani
Carpal instabilities continue to be a controversial topic in hand surgery. Accurate diagnosis of the ligament injuries is usually difficult without an arthroscopic evaluation. Few studies have focused on the diagnosis and proper management of simultaneous scapholunate (SL) and lunotriquetral (LT) ligament tears. This is an uncommon injury that leads to marked disability and chronic wrist pain. This is essentially a "floating lunate" and indicates a severe ligamentous lesion. Thirteen patients (six female and seven male) with complete SL and LT tears and with gross arthroscopic dynamic carpal instability were included in the present study...
September 2009: Hand: Official Journal of the American Association for Hand Surgery
Massimo De Filippo, Jonathan J Sudberry, Eugenio Lombardo, Maurizio Corradi, Francesco Pogliacom, Francesco Saverio Ferrari, Carlo Bocchi, Maurizio Zompatori
Carpal instability is a biomechanical alteration with a multiple pathogenesis which, if not identified and treated in time, leads to gradual articular collapse. Traumatism is known to be one of the main causes of carpal instability, while deposits of microcrystals caused by metabolic (chondrocalcinosis and gout) and congenital (ulna minus variance) diseases are less frequently involved in the pathogenesis. In forms secondary to traumatism, the trauma causes ligamentous injuries that lead to misalignments of the joint surfaces, or badly healed fractures with consequent articular incongruency...
December 2006: Acta Bio-medica: Atenei Parmensis
J N Goubier, B Bauer, J Y Alnot, F Teboul
Scapho-trapezio-trapezoid arthrodesis was originally performed for the treatment of scapho-lunate instability. However, only a few publications have described this technique for treatment of osteoarthritis of the scapho-trapezio-trapezoid (STT) joint. The purpose of this paper is to analyze the results of triscaphoid arthrodesis for STT osteoarthritis with a long-term follow-up. Thirteen cases of osteoarthritis of the STT joint in twelve patients, all treated by STT arthrodesis, were reviewed with an average follow-up of 60 months...
November 2006: Chirurgie de la Main
Nicolas H Theumann, Ghazal Etechami, Bertrand Duvoisin, Max Wintermark, Pierre Schnyder, Nicolas Favarger, Louis A Gilula
PURPOSE: To retrospectively compare the presence or absence of carpal instability on radiographs with the findings of magnetic resonance (MR) arthrographic evaluation of intrinsic and extrinsic ligament tears in patients with chronic wrist pain. MATERIALS AND METHODS: The institutional review board approved this study and did not require informed consent. Signs of carpal instability were assessed on static and dynamic radiographs of the wrist obtained in 72 patients (24 female, 48 male; mean age, 36 years; age range, 14-59 years) with posttraumatic wrist pain...
March 2006: Radiology
S A Shahane, I A Trail, V J Takwale, J H Stilwell, J K Stanley
We describe a technique of soft-tissue reconstruction which is effective for the treatment of chronic lunotriquetral instability. Part of extensor carpi ulnaris is harvested with its distal attachment preserved. It is passed through two drill holes in the triquetrum and sutured to itself. This stabilises the ulnar side of the wrist. We have reviewed 46 patients who underwent this procedure for post-traumatic lunotriquetral instability with clinical signs suggestive of ulnar-sided carpal instability. Standard radiographs were normal...
November 2005: Journal of Bone and Joint Surgery. British Volume
G-A Brunelli, G-A Brunelli
Carpal instability with scapho-lunate dissociation is still attributed to rupture of the so-called scapho-lunate ligament. Actually, this structure is not a ligament but a loose capsule allowing very different flexion of the scaphoid (92 degrees) and the lunate (20 degrees). As reconstruction of the scapho-lunate "ligament" has often been less than satisfactory we searched for another technique. Sections of the scapho-lunate "ligament" on cadaver specimens never produce scapho-lunate dissociation. This dissociation can not occur because the scaphoid is maintained in the radial facette...
April 2003: Revue de Chirurgie Orthopédique et Réparatrice de L'appareil Moteur
Ronald L Linscheid, James H Dobyns
The term carpal instability is commonly used, but what carpal stability actually is has not been defined. Much of the mechanically complex wrist's versatility is due to the intercalated three bone proximal carpal row. Landsmeer described the collapse tendency associated with intercalated segments. The factors which provide static stability are the oblique alignment of the scaphoid, the obliquely aligned dorsal and palmar ligamentous complexs, the intrinsic perilunate ligaments, the transiting transcarpal tendons and the negative intraarticular pressure...
September 2002: Keio Journal of Medicine
J K Stanley, I A Trail
No abstract text is available yet for this article.
September 1994: Journal of Bone and Joint Surgery. British Volume
M E Timins, J P Jahnke, S F Krah, S J Erickson, G F Carrera
The integrity of the ligamentous network of the wrist is critical, as disruption of this network may result in carpal instability and pain. The extrinsic (radiocarpal) and intrinsic (intercarpal) ligaments that maintain carpal stability can be evaluated with magnetic resonance (MR) imaging. The major extrinsic ligaments are the radioscaphocapitate, radiolunotriquetral, short radiolunate, and dorsal radiocarpal ligaments. The scapholunate and lunotriquetral ligaments are the most important intrinsic ligaments and the primary wrist stabilizers...
May 1995: Radiographics: a Review Publication of the Radiological Society of North America, Inc
D I Rosenthal, M Schwartz, W C Phillips, J Jupiter
Review of 190 consecutive fractures of the distal radius revealed 14 instances of ligamentous carpal instability (7.4%). Instability was more likely to occur in older patients but was not related to the degree of fracture displacement. There was an association between instability and radial styloid fracture, and in five of nine Colles fractures a separate radial styloid fragment was present, suggesting a component of avulsive force. The relatively common coexistence of fracture and instability is not generally appreciated, and the findings of instability often are overlooked...
July 1983: AJR. American Journal of Roentgenology
2014-05-04 15:37:38
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