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28 Cards in this Set
- Front
- Back
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What conditions can lead to the development of DISI?
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Scapholunate dissociation
Unstable scaphoid fracture Kienbock disease (carpal collapse + scaphoid flexes) |
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DISI results from the disruption of what two ligaments?
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Scapholunate (SL) ligament (DISI does not occur with isolated SL tear,
chronic strain of other ligaments that causes DISI) Volar radiocarpal ligaments |
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What are the components of the SL ligament?
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Dorsal
Palmar Proximal (membranous) |
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Of these, which is the strongest?
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Dorsal SL ligament
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Are the volar or dorsal radiocarpal ligaments stronger?
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Volar generally stronger
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Where is the weak spot in the volar ligaments?
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Space of Poirier
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What are five radiographic findings consistent with SL dissociation (SLD)?
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SL gap >3 mm
A break in Gilula’s arc Cortical ring sign SL angle >6O degrees l Radiolunate angle >l 5 degrees |
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What is the preferred treatment for acute SLD?
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Ligamentous repair
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In general, this can be accomplished until the injury is how old?
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6 weeks
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What are the treatment options for chronic SLD?
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Scaphoid-trapezium-trapezoid (SIT) fusion
Blatt dorsal capsulodesis Ligament reconstruction Internal fixation with SL screw Scaphoid-lunate-capitate (SLC) fusion |
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What is the potential long- term consequence of untreated scapholunate dissociation?
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Scapholunate advanced collapse (SLAC) wrist deformity
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What are the three Watson stages of arthritic change with a SLAC wrist?
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I: scaphoid-styloid arthritis
II: radioscaphoid arthritis III: capitolunate arthritis (radiolunate joint usually spared) |
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How is the progression of arthritis different with scaphoid nonunion advanced collapse (SNAC)?
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SNAC exhibits radioscaphoid sparing because proximal pole not loaded
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What is the surgical treatment for stage I SLAC?
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Debridement
Styloidectomy |
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What is the surgical treatment for stage Il SLAC?
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Scaphoid excision and four-corner fusion
Proximal row carpectomy |
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What is an alternative option available for stage II SNAC, but not for stage ll SLAC?
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Excision of distal pole of scaphoid if no scaphocapitate arthritis is present
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What is the surgical treatment for stage III SLAC?
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Scaphoid excision and four-corner fusion
Wrist fusion for pancarpal arthritis |
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lf performing a styloidectomy for a stage I SNAC wrist, what else must be done?
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ORIF and graft scaphoid
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What is Kienbock disease?
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Avascular necrosis of the lunate
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What population is particularly at risk and why?
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Ulnar negative variance
Because load on the lunate is increased Decreased radial inclination Most common in young men ages 20 to 40 |
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What are the radiographic stages of Kienbock disease (Lichtman)?
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I: positive magnetic resonance
imaging (MRI), plain films negative II: sclerosis on x-ray, no collapse IIIA: articular collapse/no carpal collapse IIIB: articular collapse/carpal collapse + DISI IV: carpal degenerative joint disease (DID) |
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What is the preferred initial treatment it for stage I disease?
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Immobilization
Nonsteroidal antiinflammatory drugs (NSAIDs) |
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What is the preferred surgical treatment for stage II?
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Radial shortening and consider revascularization
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What is the preferred surgical treatment for stage IIIA?
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Radial shorterning and consider revascularization
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What is the preferred surgical treatment for stage IIIB?
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STI fusion, capitate shortening, or proximal row carpectomy depending on stage of DISI
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What is the preferred surgical treatment for stage IV?
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Wrist arthrodesis
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Shortening the radius by 4 mm leads to what percentage decrease in radial load?
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45%
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If a patient is ulnar positive and has Kienbock disease, what is the preferred treatment?
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Capitate shortening with or without vascularized bone graft
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