Carpal dislocation and instability pattern腕关节不稳及腕关节脱位.pptVIP

Carpal dislocation and instability pattern overview The bone and ligament of the wrist form a complex mechanism Injury result in loss of function and instability Anatomy and kinematics of wrist General conceptRow theory Proximal row (scaphoid, lunate, triquetrum) Distal row (trapezium, trapezoid, capitate, hamate) intrinsic and extrinsic ligament Form midcarpal joint 50~60% of total wrist motion Scaphoid link two row, integrating motion and stability General conceptsligamentous anatomy Intrinsic ligament: the most important are scapholunate and lunotriquetral interosseous ligament Extrinsic ligament: Volar: thicker, double V, capitolunate joint space of Poirier Dorsal: Z shape Dorsal: Z shape General conceptskinematics Radiocarpal and midcarpal joint: 3 planes movement Proximal row: flex with radial deviation extend with ulnar deviation Impaired in certain instability pattern Patterns of injury 1. Progressive perilunar disruption 2. Lesser arc and greater arc patterns 3. Axial disruption patterns Progressive perilunar disruption Four stages of sequential ligamentous failure Stage I, scapholunate ligament tear ( scapholunate dissociation) Stage II, capitolunate ligament tear Stage III, lunotriquetral ligament tear (perilunate dislocation) Stage IV, dorsal radiolunate ligament tear (lunate dislocation) Perilunate injury result in lunate dislocation Lesser arc and greater arc patterns Perilunar injury involve ligament, carpal fracture or both Lesser arc pattern : pure ligamentous injury Great arc pattern: carpal fracture Combination of two pattern Most common: transcaphoid perilunate fracture-dislocation Patterns of instability 1. Dorsal and volar instability patterns 2. Dissociative and non-dissociative and complex and adaptive instability patterns 3. Static and dynamic instability patterns Dorsal and volar instability patterns Dorsal intercalated segmental instability (DISI) Scaphoid fx or scapholunate ligament tear → scaphoid and lunate disconnec