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 instability
(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
characteristics 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 graft 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 ligamentous
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 traumatic CIND and prompt treatment of injured ligaments
prior to the development of a fixed deformity.
Type of study/level of evidence
Therapeutic V.
Key words
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Article info
Publication history
Published online: June 25, 2021
Accepted:
April 21,
2021
Received:
May 10,
2020
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
