Advertisement

Acute Carpal Instability

  • Ian A. TrailEmail author
Chapter

Abstract

Instability of the carpus can range from predominantly simple inter-carpal ligament injuries e.g. scapholunate or lunotriquetral, to a complete fracture- dislocation, e.g. transcaphoid perilunar. As such, there is a spectrum of injury. The former often form part of a differential diagnosis of a scaphoid fracture, usually occurring as a result of a fall on an outstretched wrist, whilst the latter will require a more forceful injury which results in significant ligament dislocation, as well as a potential for fracture. In addition, predominantly isolated interosseous ligament injuries are often missed until symptoms become chronic and, as such, present late for definitive treatment. The pathogenesis and treatment of chronic instability will be covered in the chapter by Marc Garcia-Elias. It is, however, important to remember that these injuries almost always occur acutely and early treatment is ideal. The major disruptions are obviously easier to diagnose and should be treated as an emergency.

Keywords

Carpal fracture/dislocation Early diagnosis/investigation Complications Early management Rehabilitation Salvage 

References

  1. 1.
    Mayfield JK. Wrist ligamentous anatomy and pathogenesis of carpal instability. Orthop Clin North Am. 1984;15:209–16.PubMedGoogle Scholar
  2. 2.
    Reagan DS, Linscheid RL, Dobyns JH. Lunotriquetral sprains. J Hand Surg Am. 1984;9:502–14.PubMedCrossRefGoogle Scholar
  3. 3.
    Schroer W, Lacey S, Frost FS, Keith MW. Carpal instability in the weight-bearing upper extremity. J Bone Joint Surg Am. 1996;78:1838–43.PubMedGoogle Scholar
  4. 4.
    Garcia-Elias M, Ribe M, Rodriguez J, Cots M, Casas J. Influence of joint laxity on scaphoid kinematics. J Hand Surg Br. 1995;20:379–82.PubMedCrossRefGoogle Scholar
  5. 5.
    Berger RA, Imeada T, Berglund L, An KN. Constraint and material properties of the subregions of the scapholunate interosseous ligament. J Hand Surg Am. 1999;24:953–62.PubMedCrossRefGoogle Scholar
  6. 6.
    Katz DA, Green JK, Werner FW, Loftus JB. Capsuloligamentous restraints to dorsal and palmar carpal translation. J Hand Surg Am. 2003;28:610–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Berger RA, Kauer JM, Landsmeer JM. Radioscapholunate ligament: a gross anatomic and histologic study of fetal and adults wrists. J Hand Surg Am. 1991;16:350–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Taleisnik J. Classification of carpal instability. Bull Hosp Jt Dis Orthop Inst. 1984;44:511–31.PubMedGoogle Scholar
  9. 9.
    Trumble T, Bour CJ, Smith RJ, Edwards GS. Intercarpal arthrodesis for static and dynamic volar intercalated segment instability. J Hand Surg Am. 1988;13:384–90.PubMedCrossRefGoogle Scholar
  10. 10.
    Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part II. J Hand Surg Am. 2005;30:24–34.PubMedCrossRefGoogle Scholar
  11. 11.
    Weiss AP, Sachar K, Gendreau M. Conservative management of carpal tunnel syndrome: a reexamination of steroid injection and splinting. J Hand Surg Am. 1994;19:410–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Gilula LA, Weeks PM. Post-traumatic ligamentous instabilities of the wrist. Radiology. 1978;129:641–51.PubMedGoogle Scholar
  13. 13.
    Kelly EP, Stanley JK. Arthroscopy of the wrist. J Hand Surg Br. 1990;15:236–42.PubMedCrossRefGoogle Scholar
  14. 14.
    Watson HK, Rye J, Akelman E. Limited triscaphoid intercarpal arthrodesis for rotatory subluxation of the scaphoid. J Bone Joint Surg Am. 1986;68:345–9.PubMedGoogle Scholar
  15. 15.
    Lichtman DM, Schneider JR, Swafford AR, Mack GR. Ulnar midcarpal instability-clinical and laboratory analysis. J Hand Surg Am. 1981;6:515–23.PubMedCrossRefGoogle Scholar
  16. 16.
    Schernberg F. Roentgenographic examination of the wrist: a systematic study of the normal, lax and injured wrist. Part 1: the standard and positional views. J Hand Surg Br. 1990;15:210–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Degreif J, Benning R, Rudigier J, Ritter G. Scapholunar dissociatio--hen an accident sequela, when a normal congenital variant? Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir. 1990;731–34.Google Scholar
  18. 18.
    Stanley D, Herbert TJ. The Swanson ulnar head prosthesis for post- traumatic disorders of the distal radio-ulnar joint. J Hand Surg Br. 1992;17:682–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Herbert TJ, Faithfull RG, McCann DJ, Ireland J. Bilateral arthrography of the wrist. J Hand Surg Br. 1990;15:233–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Stewart NR, Gilula LA. CT of the wrist: a tailored approach. Radiology. 1992;183:13–20.PubMedCrossRefGoogle Scholar
  21. 21.
    Zlatkin MB, Greenan T. Magnetic resonance imaging of the wrist. Magn Reson Q. 1992;8:65–96.PubMedGoogle Scholar
  22. 22.
    Munk PL, Vellet AD, Levin MF, Steinbach LS, Helms CA. Current status of magnetic resonance imaging of the wrist. Can Assoc Radiol J. 1992;43:8–18.PubMedGoogle Scholar
  23. 23.
    Schädel-Höpfner M, Iwinska-Zelder J, Braus T, Böhringer G, Klose KJ, Gotzen L. MRI versus arthroscopy in the diagnosis of scapholunate ligament injury. J Hand Surg Br. 2001;26:17–21.PubMedCrossRefGoogle Scholar
  24. 24.
    Roth JH, Haddad RG. Radiocarpal arthroscopy and arthrography in the diagnosis of ulnar wrist pain. Arthroscopy. 1986;2:234–43.PubMedCrossRefGoogle Scholar
  25. 25.
    Cooney WP. Evaluation of chronic wrist pain by arthrography, arthroscopy, and arthrotomy. J Hand Surg Am. 1993;18:815–22.PubMedCrossRefGoogle Scholar
  26. 26.
    Dautel G, Goudot B, Merle M. Arthroscopic diagnosis of scapho-lunate instability in the absence of X-ray abnormalities. J Hand Surg Br. 1993;18:213–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Fischer M, Sennwald G. Arthroscopy in diagnosis of carpal instability. Helv Chir Acta. 1993;59:693–6.PubMedGoogle Scholar
  28. 28.
    Cooney WP, Dobyns JH, Linscheid RL. Arthroscopy of the wrist: anatomy and classification of carpal instability. Arthroscopy. 1990;6:133–40.PubMedCrossRefGoogle Scholar
  29. 29.
    Weiss AP, Akelman E. Diagnostic imaging and arthroscopy for chronic wrist pain. Orthop Clin North Am. 1995;26:759–67.PubMedGoogle Scholar
  30. 30.
    Kozin SH. The role of arthroscopy in scapholunate instability. Hand Clin. 1999;15:435–44.PubMedGoogle Scholar
  31. 31.
    Green DP, O’Brien ET. Classification and management of carpal dislocations. Clin Orthop Relat Res. 1980;149:55–72.PubMedGoogle Scholar
  32. 32.
    Johnson RP. The acutely injured wrist and its residuals. Clin Orthop. 1980;149:33–44.PubMedGoogle Scholar
  33. 33.
    Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am. 1972;54:1612–32.PubMedGoogle Scholar
  34. 34.
    Dobyns JH, Linscheid RL, Chao EYS, Weber ER, Swanson GE. Traumatic instability of the wrist. AAOS Instr Course Lect. 1975;24:182–99.Google Scholar
  35. 35.
    Dias JJ, McMohan A. Effect of Colles’ fracture malunion on carpal alignment. J R Coll Surg Edinb. 1988;33:303–5.PubMedGoogle Scholar
  36. 36.
    Dobyns JH, Gabel GT. Gymnast’s wrist. Hand Clin. 1990;6:493–505.PubMedGoogle Scholar
  37. 37.
    Green DP, O’Brien ET. Open reduction of carpal dislocations: indications and operative techniques. J Hand Surg Am. 1978;3:250–65.PubMedCrossRefGoogle Scholar
  38. 38.
    Minami A, Kaneda K. Repair and/or reconstruction of scapholunate interosseous ligament in lunte and perilunate dislocations. J Hand Surg Am. 1993;18:1099–106.PubMedCrossRefGoogle Scholar
  39. 39.
    Sotereanos DG, Mitsionis GJ, Giannakopoulos PN, Tomaino MM, Herndon JH. Perilunate dislocation and fracture dislocation: a critical analysis of the volar-dorsal approach. J Hand Surg Am. 1997;22:49–56.PubMedCrossRefGoogle Scholar
  40. 40.
    Garcia-Elias M, Irisarri C, Henriquez A, Abanco J, Fores J, Lluch A, Gilabert A. Perilunar dislocation of the carpus. Ann Chir Main. 1986;5(4):281–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Berger RA. Ligament anatomy. In: Cooney WP, Linscheid RL, Dobyns JH, editors. The wrist. Diagnosis and operative treatment. St. Louis: Mosby; 1998. p. 73–105.Google Scholar
  42. 42.
    Rosati M, Parchi P, Cacianti M, Poggetti A, Lisanti M. Treatment of acute scapholunate ligament injuries with bone anchor. Musculoskelet Surg. 2010;94:25–32.PubMedCrossRefGoogle Scholar
  43. 43.
    Jeon L-H, Kim H-J, Min W-K, Cho H-S, Kim P-T. Arthroscopically assisted percutaneous fixation for trans-scaphoid perilunate fracture dislocation. J Hand Surg Br. 2010;35(8):884–8.Google Scholar
  44. 44.
    Moneim MS, Hofammann KE, Omer GE. Transscaphoid perilunate fracture-dislocation. Clin Orthop Relat Res. 1984;190:227–35.PubMedGoogle Scholar
  45. 45.
    Inoue G, Tanaka Y, Nakamura R. Treatment of trans-scaphoid perilunate dislocations by internal fixation with the Herbert screw. J Hand Surg Br. 1990;15:449–54.PubMedCrossRefGoogle Scholar
  46. 46.
    Herzberg G, Comtet JJ, Linscheid RL, Amadio PC, Cooney WP, Stalder J. Perilunate dislocations and fracture dislocations: a multicentre study. J Hand Surg Am. 1993;18:768–79.PubMedCrossRefGoogle Scholar
  47. 47.
    Forli A, Courvoisier A, Wimsey S, Corcella D, Moutet F. Perilunate dislocations and transscaphoid perilunate fracture-dislocations: a retrospective study with minimum ten-year follow-up. J Hand Surg Am. 2010;35:62–8.PubMedCrossRefGoogle Scholar
  48. 48.
    White RE, Omer GE. Transient vascular compromise of the lunate after fracture-dislocation or dislocation of the carpus. J Hand Surg Am. 1984;9:181–4.PubMedCrossRefGoogle Scholar
  49. 49.
    Monahan PR, Galasko CS. The scapho-capitate fracture syndrome: a mechanism of injury. J Bone Joint Surg Br. 1972;54:122–4.PubMedGoogle Scholar
  50. 50.
    Siegert JJ, Frassica FJ, Amadio PC. Treatment of chronic perilunate dislocations. J Hand Surg Am. 1988;13:206–12.PubMedCrossRefGoogle Scholar
  51. 51.
    Weir IGC. The late reduction of carpal dislocations. J Hand Surg Br. 1992;17:137–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Fernandez DL, Ghillani R. External fixation of complex carpal dislocations: a preliminary report. J Hand Surg Am. 1987;12:335–47.PubMedCrossRefGoogle Scholar
  53. 53.
    O’Meeghan CJ, Stuart W, Mamo V, Stanley JK, Trail IA. The natural history of an untreated isolated scapholunate interosseous ligament injury. J Hand Surg Br. 2003;28:307–10.PubMedCrossRefGoogle Scholar
  54. 54.
    Palmer AK, Dobyns JH, Linscheid RL. Management of post-traumatic instability of the wrist secondary to ligament rupture. J Hand Surg Am. 1978;3:507–32.PubMedCrossRefGoogle Scholar
  55. 55.
    Wyrick JD, Youse BD, Kiefhaber TR. Scapholunate ligament repair and capsulodesis for the treatment of static scapholunate dissociation. J Hand Surg Br. 1998;23:776–80.PubMedCrossRefGoogle Scholar
  56. 56.
    Bickert B, Sauerbier M, Germann G. Scapholunate ligament repair using the Mitek bone anchor. J Hand Surg Br. 2000;25:188–92.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Upper Limb Research DepartmentWrightington HospitalWiganUK

Personalised recommendations