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Carpal Instability: an overview Abdelsalam Eid Assistant Professor of Orthopaedic Surgery. Zagazig University Abdelsalam Eid, Zagazig University.

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Presentation on theme: "Carpal Instability: an overview Abdelsalam Eid Assistant Professor of Orthopaedic Surgery. Zagazig University Abdelsalam Eid, Zagazig University."— Presentation transcript:

1 Carpal Instability: an overview Abdelsalam Eid Assistant Professor of Orthopaedic Surgery. Zagazig University Abdelsalam Eid, Zagazig University

2 Wrist Stabilizers zComplex interlocking shapes zIntrinsic and extrinsic ligaments yExtrinsic ligaments xVolar stronger than dorsal yIntrinsic ligaments xImportant interosseous ligaments are SLIL and LTIL

3 Abdelsalam Eid, Zagazig University Axes of Motion

4 Abdelsalam Eid, Zagazig University Kinematics zRows yProximal and Distal with scaphoid as a bridge yMotion within and between rows zColumns yCentral(flex/ext) lunate,capitate,hamate yLateral (longitudinal stability) scaphoid,trapezoid,trapezium yMedial (rotation) triquetrum

5 Abdelsalam Eid, Zagazig University Kinematics zCenter of rotation : head of capitate

6 Abdelsalam Eid, Zagazig University Force Transmission zPrincipal force transmission is through capitate lunate and proximal pole of scaphoid z75% radius 25% ulna

7 Abdelsalam Eid, Zagazig University Kinematics What happens when the wrist moves zRadial deviation : scaphoid flexes “pulling” lunate into palmar flexion zUlnar deviation : scaphoid extends pulling lunate into dorsiflexion zTriquetrohamate helicoid joint zUlnar deviation : hamate rotates into “low” position distal causing the triquetrum to dorsiflex pulling lunate into dorsiflexion zRadial deviation : : hamate rotates into “high”position proximal causing the triquetrum to palmar flex pulling lunate into palmar flexion zSo in conclusion, in radial deviation the proximal row flexes and in ulnar deviation it extends

8 Pathomechanics Carpal Instability zintercalated segment zlunate is in state of dynamic balance zscaphoid induced to flex under compressive load and induces flexion force on lunate ztriquetral inherently prefers to extend and induces extension force on lunate zdynamic balance interrupted, lunate follows unbalanced force Abdelsalam Eid, Zagazig University

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10 Definition~ Carpal Instability zCarpal malalignment caused by injury or disease Abdelsalam Eid, Zagazig University

11 Classification of Carpal Instability zCID (dissociative) yDISI yVISI zCIND (non-dissociative) yRadiocarpal,Midcarpal,Ulnar translocation zCIC (complex) yPerilunate Dislocation zCIA (adaptive) yinstability not in carpus ymalunited wrist fr.

12 MUN ORTHOPEDICS Carpal instability terminology zdynamic yNeg Xray;+ve stress testing e.g.Watson:+ve cineradiography zstatic y +ve plain films zDegenerative zSecondary yKienbock’s ; SNAC

13 Abdelsalam Eid, Zagazig University Normal wrist

14 Groups... CID zcarpal instability dissociative zInstability due to loss of linkage between individual carpal bones zbones of same row zshort ligaments zProximal Dissociative Carpal Instability (DISI and VISI) yunstable scaphoid non-union yscapholunate dissociation ylunotriquetral dissociation zDistal Dissociative Carpal Instability CID yvery rare yrupture of ligaments of distal row yAcute -> repair/ Chronic ->fuse Abdelsalam Eid, Zagazig University

15 Dorsal Intercalated Segment Instability

16 Abdelsalam Eid, Zagazig University Volar Intercalated Segment Instability

17 Scaphoid Nonunion zproximal scaphoid pole follows unconstrained lunate and triquetrum and rotates into extension ( hump back deformity) zDISI ztreat the scaphoid N U zMost common Abdelsalam Eid, Zagazig University

18 Scapholunate Instability zcomplete disruption of SL ligament zscaphoid flexes zlunate and triquetrum rotate into extension zDISI zRecent -> Open and repair dorsal portion of SL interosseous lig. zstabilise with K wires two months Abdelsalam Eid, Zagazig University

19 MUN ORTHOPEDICS Scapholunate Instability

20 Chronic SL instability zdegenerative changes zSLAC z4 corner fusion with resection of scaphoid zPRC Abdelsalam Eid, Zagazig University

21 Lunotriquetral dissociation zdissociative VISI zLunate loses support from triquetrum zpalmar flexion of lunate with the scaphoid zless common zacute -> repair zlate -> lunotriquetral arthrodesis Abdelsalam Eid, Zagazig University

22 Groups... CIND znondissociative carpal instability zdysfunction between rows z zinstability at radiocarpal or midcarpal joints Abdelsalam Eid, Zagazig University

23 Non-dissociative radiocarpal instability zdorsal malunion of distal radius znot a true carpal instability zadaptive zcorrective osteotomy Abdelsalam Eid, Zagazig University

24 Groups CIC zcarpal instability complex zCID & CIND yperilunate dislocation yinstabilities not otherwise classifiable Abdelsalam Eid, Zagazig University

25 Perilunate Dislocation zStill missed in ER zTtt of choice : open reduction & repair of ligaments/bones zDorsal and volar approach zLate: fusion or PRC

26 Thank you. Abdelsalam Eid, Zagazig University


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