Carpal Instability*† by Richard H. Gelberman, William P. Cooney, and Robert M. Szabo J Bone Joint Surg Am Volume 82(4):578-578 April 1, 2000 ©2000 by The.

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Presentation transcript:

Carpal Instability*† by Richard H. Gelberman, William P. Cooney, and Robert M. Szabo J Bone Joint Surg Am Volume 82(4): April 1, 2000 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Illustration demonstrating the scapholunate and lunotriquetral interosseous ligaments (arrows). Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Illustration demonstrating the palmar wrist ligaments. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Illustration demonstrating the dorsal wrist ligaments. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Illustration demonstrating Navarro's columnar carpus12. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Illustration demonstrating Taleisnik's modification of the columnar carpus8. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Illustration demonstrating the oval ring concept of Lichtman et al.14. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Gilford et al. described the wrist as a link joint (Fig. 7, A), noting that instability occurs in compression because of the intercalated segment (the proximal carpal row represented by the lunate [L]) (Fig. 7, B). Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 8-A, 8-B, and 8-C: Midcarpal arthrograms diagnostic for a lunotriquetral ligament tear.Fig. 8-A: Contrast material is injected into the midcarpal joint. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Contrast material is noted to extend across the lunotriquetral joint (arrow). Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Contrast material fills the scapholunate interval but does not cross at this location into the radiocarpal joint. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 9 and 10: A wrist with acute static scapholunate dissociation.Fig. 9: Posteroanterior radiograph. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Lateral radiograph demonstrating an increased scapholunate angle as measured with the tangential measurement method. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 11 through 14: A wrist with acute stage-III dorsal perilunate dislocation according to the system of Mayfield et al.18,19.Fig. 11: Preoperative posteroanterior radiograph demonstrating overlap of the carpal bones (normally only the trapezium and the t... Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Preoperative lateral radiograph demonstrating that while the lunate is palmar flexed it rests in the lunate fossa of the radius. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Postoperative posteroanterior radiograph demonstrating reduction of the scaphoid with fixation of the scaphoid to the lunate with two inch (0.114-centimeter) Kirschner wires. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Postoperative lateral radiograph demonstrating that the capitate and the lunate are colinear with the radius and that the capitate is concentric with the articular surface of the lunate. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Photograph demonstrating how point tenderness over the scapholunate interval is elicited in wrists with dynamic scapholunate instability. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 16-A, 16-B, and 16-C: Photographs demonstrating the scaphoid shift maneuver.Figs. 16-A and 16-B: Volar and lateral views showing how the maneuver is performed by applying pressure over the scaphoid while the wrist is held in ulnar deviation. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Fig. 16-C: As the wrist is brought from ulnar to radial deviation, the scaphoid's proximal pole returns to its position in the scaphoid fossa of the radius. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 17 and 18: Photograph and radiograph demonstrating the technique of dorsal capsulodesis.Fig. 17: Dorsal capsulodesis is performed by creating a transversely directed trough in the distal portion of the scaphoid. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

One or two inch (0.114-centimeter) Kirschner wires, inserted through the scaphoid's distal pole, provide stabilization to the capitate. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Posteroanterior radiograph of the wrist, demonstrating stage-III scapholunate advanced collapse. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 20-A and 20-B: Posteroanterior and lateral radiographs showing a malunion of the distal part of the radius. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Schematic drawing of a wrist with midcarpal instability demonstrating flexion of the lunocapitate joint. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Radiograph showing a malunion of the distal part of the radius with 40 degrees of dorsiflexion of the distal part of the radius, a scapholunate angle of 75 degrees, and a lunocapitate angle of 15 degrees. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Schematic drawings of a corrective osteotomy, showing interposition of bone graft from the iliac crest to restore the length and tilt of the distal part of the radius. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Postoperative lateral radiograph showing the scapholunate angle corrected to 45 degrees and the lunocapitate angle corrected to less than 5 degrees after corrective osteotomy for the treatment of malunion of the distal part of the radius. Richard H. Gelberman et al. J Bone Joint Surg Am 2000;82:578 ©2000 by The Journal of Bone and Joint Surgery, Inc.