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Abstract：
We report 8 cases of acute or subacute unilateral nondissociative carpal instability (CIND) in the context of nondisplaced scaphoid fractures.
Eight patients from 3 centers developed abnormal volar intercalated segment instability (VISI) or dorsal intercalated segment instability (DISI) following the diagnosis of a nondisplaced scaphoid fracture. An operative inspection in each patient confirmed intact scapholunate and lunotriquetral interosseous ligaments. We outline the demographic characteristics of our patient cohort, radiologic and operative findings of CIND-DISI and CIND-VISI, and the outcomes of acute and delayed treatment.
Two patients were diagnosed with CIND-DISI and 6 with CIND-VISI associated with ipsilateral nondisplaced scaphoid fractures. The average time from injury to diagnosis of CIND was 11 weeks, and the mean clinical and radiographic follow-up was 18 months. Rapid healing of the scaphoid fractures was achieved in all patients (4 open reduction internal fixation, 4 cast). All patients underwent surgery to improve proximal carpal row alignment: in 3 of the 4 patients who were diagnosed and treated surgically within 12 weeks of injury, the radiolunate angle (RLA) was successfully restored. A contracture release and ligament repair or reconstruction with tendon graft 12 or more weeks following injury was unsuccessful in restoring proximal row alignment in all 4 patients. Two patients in the delayed treatment group required secondary surgery for partial fusion.
Based on the arthroscopic, imaging, and operative findings, we propose that the ligamentous restraints to CIND-VISI are dorsal at the radiocarpal joint and volar at the midcarpal joint. Conversely, the ligamentous restraints to CIND-DISI are dorsal at the midcarpal joint and volar at both the radiocarpal and midcarpal joints. In our series, a delayed diagnosis and late reconstructive surgery were associated with no improvement in RLA. We recommend early recognition of traumatic CIND and prompt treatment of injured ligaments prior to the development of a fixed deformity.
Therapeutic V.
Eight patients from 3 centers developed abnormal volar intercalated segment instability (VISI) or dorsal intercalated segment instability (DISI) following the diagnosis of a nondisplaced scaphoid fracture. An operative inspection in each patient confirmed intact scapholunate and lunotriquetral interosseous ligaments. We outline the demographic characteristics of our patient cohort, radiologic and operative findings of CIND-DISI and CIND-VISI, and the outcomes of acute and delayed treatment.
Two patients were diagnosed with CIND-DISI and 6 with CIND-VISI associated with ipsilateral nondisplaced scaphoid fractures. The average time from injury to diagnosis of CIND was 11 weeks, and the mean clinical and radiographic follow-up was 18 months. Rapid healing of the scaphoid fractures was achieved in all patients (4 open reduction internal fixation, 4 cast). All patients underwent surgery to improve proximal carpal row alignment: in 3 of the 4 patients who were diagnosed and treated surgically within 12 weeks of injury, the radiolunate angle (RLA) was successfully restored. A contracture release and ligament repair or reconstruction with tendon graft 12 or more weeks following injury was unsuccessful in restoring proximal row alignment in all 4 patients. Two patients in the delayed treatment group required secondary surgery for partial fusion.
Based on the arthroscopic, imaging, and operative findings, we propose that the ligamentous restraints to CIND-VISI are dorsal at the radiocarpal joint and volar at the midcarpal joint. Conversely, the ligamentous restraints to CIND-DISI are dorsal at the midcarpal joint and volar at both the radiocarpal and midcarpal joints. In our series, a delayed diagnosis and late reconstructive surgery were associated with no improvement in RLA. We recommend early recognition of traumatic CIND and prompt treatment of injured ligaments prior to the development of a fixed deformity.
Therapeutic V.
摘要：
我们报告了8例急性或亚急性单侧非分离性腕骨不稳定（CIND）在非移位舟骨骨折的情况下。
来自3个中心的8名患者在诊断为非移位舟骨骨折后出现了异常的掌侧插层节段不稳定(VISI)或背侧插层节段不稳定(DISI)。对每位患者进行的手术检查均确认了完整的肩胛骨和小脑骨间韧带。我们概述了患者队列的人口统计学特征，CIND-DISI和CIND-VISI的放射学和手术发现，以及急性和延迟治疗的结果。
2例患者诊断为CIND-DISI，6例诊断为CIND-VISI与同侧非移位舟骨骨折相关。从损伤到诊断CIND的平均时间为11周，平均临床和影像学随访时间为18个月.所有患者均能快速愈合舟骨骨折（4例切开复位内固定，4铸造）。所有患者均接受手术以改善近端腕排对齐：在受伤12周内通过手术诊断和治疗的4例患者中，有3例，已成功恢复放射性束角(RLA)。损伤后12周或更长时间，肌腱移植物的挛缩释放和韧带修复或重建未能恢复所有4例患者的近端排线。延迟治疗组的两名患者需要二次手术进行部分融合。
根据关节镜，成像,和手术发现，我们建议对CIND-VISI的韧带约束在ri腕关节的背侧和腕关节的掌侧。相反，对CIND-DISI的韧带约束在腕中关节的背侧，并且在ri腕骨和腕中关节的掌侧。在我们的系列中,延迟诊断和晚期重建手术与RLA无改善相关.我们建议在发生固定畸形之前，及早发现创伤性CIND并迅速治疗受伤的韧带。
治疗性V.
来自3个中心的8名患者在诊断为非移位舟骨骨折后出现了异常的掌侧插层节段不稳定(VISI)或背侧插层节段不稳定(DISI)。对每位患者进行的手术检查均确认了完整的肩胛骨和小脑骨间韧带。我们概述了患者队列的人口统计学特征，CIND-DISI和CIND-VISI的放射学和手术发现，以及急性和延迟治疗的结果。
2例患者诊断为CIND-DISI，6例诊断为CIND-VISI与同侧非移位舟骨骨折相关。从损伤到诊断CIND的平均时间为11周，平均临床和影像学随访时间为18个月.所有患者均能快速愈合舟骨骨折（4例切开复位内固定，4铸造）。所有患者均接受手术以改善近端腕排对齐：在受伤12周内通过手术诊断和治疗的4例患者中，有3例，已成功恢复放射性束角(RLA)。损伤后12周或更长时间，肌腱移植物的挛缩释放和韧带修复或重建未能恢复所有4例患者的近端排线。延迟治疗组的两名患者需要二次手术进行部分融合。
根据关节镜，成像,和手术发现，我们建议对CIND-VISI的韧带约束在ri腕关节的背侧和腕关节的掌侧。相反，对CIND-DISI的韧带约束在腕中关节的背侧，并且在ri腕骨和腕中关节的掌侧。在我们的系列中,延迟诊断和晚期重建手术与RLA无改善相关.我们建议在发生固定畸形之前，及早发现创伤性CIND并迅速治疗受伤的韧带。
治疗性V.
