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Carpal injuries
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
As stated earlier, the position of the lunate is under dynamic control of simultaneous forces applied by the SLIL and LTIL. When the SLIL is disrupted, the scaphoid flexes further while the lunate extends under the unopposed pull of the triquetrum. This is associated with an increased capitolunate angle and dorsal translation of the distal carpal row. The resultant deformity is termed dorsal intercalated segment instability (DISI). Other processes can lead to a similar clinical picture, including scaphoid non-union and scaphotrapeziotrapezoidal pathology.
Complications of Treatment of the Hand
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Scapholunate dissociation may require dynamic stress views to demonstrate. The tear of the scapholunate ligament allows the scaphoid to drop and the lunate to tilt dorsally, since the two bones are no longer connected. On a lateral x-ray, the result is that the angle between the axis of the scaphoid and a line across the upper lunate drops from 47° to 10°–15°. Furthermore, the capitate and metacarpals (MCs) shift dorsally and are no longer in line with the radius. This is a dorsal intercalated segmental instability (DISI). AP views may show a gap or space between the scaphoid and lunate. With time and progression the capitate may drop down into the scapholunate interval with a shortened, widened carpus.
Arthritis
Published in Harry Griffiths, Musculoskeletal Radiology, 2008
Similarly, primary degenerative arthritis is rare in the wrist but often accompanies other disorders, such as chronic disability as is seen in association with dorsal intercalary segmental instability (DISI), volar intercalary segmental instability (VISI), and the scapholunate advance collapse (SLAC) wrist. It can also be seen as a secondary phenomenon in CPPD, rheumatoid arthritis, juvenile chronic arthritis, and in other forms of arthritis. On the other hand, degenerative arthritis of the first carpometacarpal joint is common in patients older than 50 (Fig. 13).
Treatment of unstable scaphoid waist nonunion with cancellous bone grafts and cannulated screw or Kirschner wire fixation
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Galal Hegazy, Mahmoud Seddik, Tharwat Abd-Elghany, Mohamed Abdelaal, Mohamed Abdelaziz, Ehab Elzahed, Yasser Saqr, Elsayed Seif
The natural history of the untreated scaphoid waist fracture is nonunion that often involves apex dorsal angulation with bone loss and collapse resulting in scaphoid nonunion advanced collapse (SNAC) which characterized by humpback or flexion deformity of the scaphoid [1,2]. The humpback deformity characterized by an increased lateral intrascaphoid angle because of the shortening of the volar cortical length of the scaphoid. The deformity can cause dorsal intercalated segmental instability (DISI) because of the extension of the lunate with the proximal scaphoid fragment [3,4]. Surgical treatment is directed at correction of the deformity, restoration of normal carpal alignment, promotion of bone union, and improvement of wrist function [4]. The reference internal fixation and bone grafting is one of the most frequently used surgical procedures for scaphoid nonunion [5]. However, many other techniques are to be considered still valid and effective [6–10]. The purpose of this study was to compare the impact of Herbert screw [11] versus multiple Kirschner wires [12] fixation method on the scaphoid union, union time, deformity correction, clinical outcomes (wrist pain, grip strength, and range of motion [ROM]), and the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) [13] score in adults with unstable scaphoid waist nonunions.
Pain, impaired functioning, poor satisfaction and diminished health status eight years following perilunate (fracture) dislocations
Published in Disability and Rehabilitation, 2020
Charlotte M. Lameijer, Caren K. Niezen, Mostafa El Moumni, Corry K. van der Sluis
All pain scales showed that patients experienced more pain than the matched controls. Clinicians treating these patients should therefore realize that pain is a considerable problem in PLD/PLFD patients and should treat these patients accordingly, e.g., by prescribing pain medication and proposing rehabilitation strategies. If all non-operative treatments fail, partial or complete wrist denervation might be a successful, although mostly temporary, solution [36–38]. Wrist denervation is a symptomatic treatment and selectively eliminates the anterior and posterior interosseous nerves, which innervate the central two-thirds of the anterior and posterior carpal joint capsule, respectively [39]. Removal of these sensory innervations of the wrist joint provides relief of pain, while maintaining function and mobility of the hand and wrist [39]. Studies report satisfactory results with short term follow up. One third of the patients need revision surgery at longer follow up duration [36–38]. In addition, several authors state that the degree of pain relief following wrist denervation is inadequate for the patients who perform heavy manual labor [19,38]. Another surgical treatment option for patients following PLD/PLFDs with pain is (partial) arthrodesis [12,19]. Many techniques have been described, including arthroplasty, limited or total fusion, partial or total joint replacement, interpositional arthroplasty and ribcartilage graft implantation [19]. It is important to indicate with physical examination, radiographs and computed tomography, what joints are causing the painful wrist before choosing a technique [19]. Laulan et al. suggest an algorithm for choosing the right treatment on basis of the severity of the scapholunate advanced collapse (SLAC), volar/dorsal intercalated segment instability (VISI/DISI) of the proximal carpal row and patient characteristics [18]. However an arthrodesis may not help all: the patient in our study who received the four-corner arthrodesis remained to have moderate pain [40,41]. Martini et al. stated that the use of a partial arthrodesis is only a temporary solution for treating pain [42]. Following a total wrist arthrodesis a mean VAS of 2/10 combined with 80–90% of normal strength can be expected and most patients are able to return to their previous occupation [18]. In addition, patients rarely perceive the loss of mobility as problematic and patient satisfaction rates range from 80–100% [43].