Carpal Instability-Case: Carpal Instability

Case: Carpal Instability

Pdf Summary

This learning module discusses a case of a 21-year-old healthy male who fell on his outstretched hand and presented with left-sided wrist pain. The physical exam revealed limited wrist motion and a gross deformity with swelling. X-ray imaging was performed to further evaluate the injury.<br /><br />The module discusses various considerations for the work-up and treatment of carpal instability complex. These considerations include the timing of surgery, whether closed reduction should be attempted, assessing for acute carpal tunnel syndrome, and using the Mayfield classification to categorize the type of carpal instability.<br /><br />The module then covers the exposure, reduction, pinning, and ORIF (open reduction and internal fixation) techniques that may be used to treat the carpal instability complex. A 12-week follow-up is recommended, which includes pin removal.<br /><br />Post-operatively, the module addresses questions such as the length of immobilization, functional outcomes, and considerations for an incompletely corrected DISI deformity. It also discusses what would happen if the case presented at 6 weeks post-injury.<br /><br />The take-home points from this module include the fact that the most common carpal instability pattern is a scapholunate ligament dissociation and that the Watson shift test can be used to assess scapholunate ligament competence. Scapholunate dissociation may lead to a DISI deformity, and the Mayfield classification can categorize progressive perilunar instability. Additionally, the module explains the difference between greater arc and lesser arc injuries, with greater arc injuries involving a fracture and lesser arc injuries not involving a fracture.

Keywords

wrist pain

limited wrist motion

gross deformity

carpal instability complex

Mayfield classification

ORIF

12-week follow-up

DISI deformity

scapholunate ligament dissociation

fracture