Non Dissociative Carpal Instability [CIND]
Non dissociative Carpal Instability [CIND] is defined as an alteration in the articular relationship between the two carpal rows, while the individual joints between the skeletal elements of each row are maintained.
The most frequent reasons of non dissociative carpal instability are the collapse of the capsule and that of the intercarpal ligaments mostly following rheumatoid arthritis. Trauma is another cause.
- Capitolunate instability: Palmar subluxation of the capitate on the lunate.
- Scaphoid trapezium trapezoid instability
- Ulnar mid-carpal instability
- Radio-carpal instability as in distal radial malunion
There would be history of wrist giving way. Pain is not present in all patients.
On examination there is a painful clunk on movements of wrist with simultaneous axial loading.
Ulnar gutter splint relieves symptoms in about one third of patients.
Operative treatment is indicated if nonoperative management fails.
In midcarpal instability midcarpal joint fusion is done.
Ulnar translation requires open repair, reduction, and pinning in early stage of the disease. Late repair is associated with poor outcomes.
Distal radius malunion require correction of the malunion or fusion of radiocarpal joint in selected cases.
A radial shortening procedure like closing wedge osteotomy may be done in cases with negative ulnar variance. It may improve the dynamics of the proximal row.
Radial shortening osteotomy may improve the sliding dynamics of the proximal carpi and may prevent the clunk which is characteristic of midcarpal instability;
Dissociative Carpal Instability
- Scapholunate instability
- Lunotriquetral dissociation
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