Carpal instability can be dynamic or static. VICI , DICI , radiocarpal dislocation and peri lunate dislocation explained briefly.

1. Carpal instability
Dr Humayun Israr
PGR ortho
STH, Sahiwal

2. The wrist Joint

4. Dynamic instability
Dynamic Instability
 Maintains normal alignment at rest but will collapse under applied load.
Static Instability
 Abnormal Intercarpal alignment on static radiographs

5. Carpal instability
Carpal Instability (dissociative)
Instability occurs between the individual bones in the same row. Eg VISI and DISI
Carpal Instability (non dissociative)
Instability occurs between the row of bones

6. DISI
 Stands for Dorsal intercalated segmental instability
 Scapholunate ligament disruption
 Scaphoid will hyperflex and lunate will hyper extend
Presention
Hx of FOOSH or degenerative rupture
Symptoms include dorsal and radial sided wrist pain.

7. DISI
Examination
Dorsal wrist pain
Diminished grip strength
Pain increased with increased wrist extension and radial deviation

9. Scaphoid shift test for carpal instability

10. Terry Thomas sign

13. Treatment
 NSAID,Rest + immobilization
Acute less displaced and chronic asymptomatic
 SL ligament reconstruction
SL ligament reconstruction for reducible and repairable injuries
 Wrist Fusion
Rigid and unreducible dislocations

14. VISI
 Stands for Volar Intercalated segmental instability
 Instability of lunotriquetral ligament
 Lunate and scaphoid will hyper flex.
 Presentation
Ulnar side wrist pain
Increased with ulnar deviation

15. Ballottement Test

16. Gulila’s Arc

19. Treatment
 Closed Reduction & percutaneous pinning with lunotriquetral repair
Indicated for acute instability
 Lunotriquetral repair
For chronic instability
 Arthroscopic debridement with ulnar shortening
Chronic instability secondary to ulnar positive variance

20. Extrinsic Ligaments disruptions
 Radioscaphocapitate
 Long radiolunate
 Short radiolunate
 Radioscapholunate

21. Associated conditions
 Intercarpal ligament(Scapholunate and lunotriquetral ligament)
 Carpal tunnel syndrome
 Compartment syndrome

22. Prognosis
 Volar dislocation is more severe than dorsal.

23. Radiocarpal dislocation

25. Treatment
 Immobilization and splint
First line
 Open reduction repair and pinning
 Midcarpal joint fusion
 Distal radius osteotomy
May lead to malunion distal radius
 Wrist arthrodesis
Failure of above treatments

26. Peri-Lunate dislocation
 Mechanism
Forced dorsiflexion
Ulnar deviation
Supination

27. Piece of pie sign

28. Mayfield classification

29. Space of poirier
SPACE OF POIRIER Ligament free area between
Radioscaphocapitate ligament and radiolunate
ligament at level of mid carpal areaofpotentialweakness

30. Treatment
 Closed Reduction and casting
 Closed Reduction / splinting followed by open reduction ligament repair,
fixation and possible carpal tunnel release
All acute injuries less than 8 weeks old
 Proximal row carpectomy
Chronic injuries greater than 8 weeks old
 Total wrist Arthrodesis
Chronic injuries with degenerative changes