Carpal Instability: an overview - PowerPoint PPT Presentation

Loading...

PPT – Carpal Instability: an overview PowerPoint presentation | free to download - id: 7d93cc-OTVhM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Carpal Instability: an overview

Description:

Carpal Instability: an overview Abdelsalam Eid Assistant Professor of Orthopaedic Surgery. Zagazig University Abdelsalam Eid, Zagazig University Abdelsalam Eid ... – PowerPoint PPT presentation

Number of Views:214
Avg rating:3.0/5.0
Slides: 27
Provided by: Alexand219
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Carpal Instability: an overview


1
Carpal Instability an overview
  • Abdelsalam Eid Assistant Professor of Orthopaedic
    Surgery.
  • Zagazig University

2
Wrist Stabilizers
  • Complex interlocking shapes
  • Intrinsic and extrinsic ligaments
  • Extrinsic ligaments
  • Volar stronger than dorsal
  • Intrinsic ligaments
  • Important interosseous ligaments are SLIL and LTIL

3
Axes of Motion
4
Kinematics
  • Rows
  • Proximal and Distal with scaphoid as a bridge
  • Motion within and between rows
  • Columns
  • Central(flex/ext) lunate,capitate,hamate
  • Lateral (longitudinal stability)
    scaphoid,trapezoid,trapezium
  • Medial (rotation) triquetrum

5
Kinematics
  • Center of rotation head of capitate

6
Force Transmission
  • Principal force transmission is through capitate
    lunate and proximal pole of scaphoid
  • 75 radius 25 ulna

7
Kinematics What happens when the wrist moves
  • Radial deviation scaphoid flexes pulling
    lunate into palmar flexion
  • Ulnar deviation scaphoid extends pulling lunate
    into dorsiflexion
  • Triquetrohamate helicoid joint
  • Ulnar deviation hamate rotates into low
    position distal causing the triquetrum to
    dorsiflex pulling lunate into dorsiflexion
  • Radial deviation hamate rotates into
    highposition proximal causing the triquetrum to
    palmar flex pulling lunate into palmar flexion
  • So in conclusion, in radial deviation the
    proximal row flexes and in ulnar deviation it
    extends

8
Pathomechanics Carpal Instability
  • intercalated segment
  • lunate is in state of dynamic balance
  • scaphoid induced to flex under compressive load
    and induces flexion force on lunate
  • triquetral inherently prefers to extend and
    induces extension force on lunate
  • dynamic balance interrupted, lunate follows
    unbalanced force

9
(No Transcript)
10
Definition Carpal Instability
  • Carpal malalignment caused by injury or disease

11
Classification of Carpal Instability
  • CID (dissociative)
  • DISI
  • VISI
  • CIND (non-dissociative)
  • Radiocarpal,Midcarpal,Ulnar translocation
  • CIC (complex)
  • Perilunate Dislocation
  • CIA (adaptive)
  • instability not in carpus
  • malunited wrist fr.

12
Carpal instability terminology
  • dynamic
  • Neg Xrayve stress testing e.g.Watsonve
    cineradiography
  • static
  • ve plain films
  • Degenerative
  • Secondary
  • Kienbocks SNAC

13
Normal wrist
14
Groups ...CID
  • carpal instability dissociative
  • Instability due to loss of linkage between
    individual carpal bones
  • bones of same row
  • short ligaments
  • Proximal Dissociative Carpal Instability (DISI
    and VISI)
  • unstable scaphoid non-union
  • scapholunate dissociation
  • lunotriquetral dissociation
  • Distal Dissociative Carpal Instability CID
  • very rare
  • rupture of ligaments of distal row
  • Acute -gt repair/ Chronic -gtfuse

15
Dorsal Intercalated Segment Instability
16
Volar Intercalated Segment Instability
17
Scaphoid Nonunion
  • proximal scaphoid pole follows unconstrained
    lunate and triquetrum and rotates into extension
    ( hump back deformity)
  • DISI
  • treat the scaphoid N U
  • Most common

18
Scapholunate Instability
  • complete disruption of SL ligament
  • scaphoid flexes
  • lunate and triquetrum rotate into extension
  • DISI
  • Recent -gt Open and repair dorsal portion of SL
    interosseous lig.
  • stabilise with K wires two months

19
Scapholunate Instability
20
Chronic SL instability
  • degenerative changes
  • SLAC
  • 4 corner fusion with resection of scaphoid
  • PRC

21
Lunotriquetral dissociation
  • dissociative VISI
  • Lunate loses support from triquetrum
  • palmar flexion of lunate with the scaphoid
  • less common
  • acute -gt repair
  • late -gt lunotriquetral arthrodesis

22
Groups ...CIND
  • nondissociative carpal instability
  • dysfunction between rows
  • instability at radiocarpal or midcarpal joints

23
Non-dissociative radiocarpal instability
  • dorsal malunion of distal radius
  • not a true carpal instability
  • adaptive
  • corrective osteotomy

24
Groups CIC
  • carpal instability complex
  • CID CIND
  • perilunate dislocation
  • instabilities not otherwise classifiable

25
Perilunate Dislocation
  • Still missed in ER
  • Ttt of choice open reduction repair of
    ligaments/bones
  • Dorsal and volar approach
  • Late fusion or PRC

26
Thank you.
About PowerShow.com