Department of hand surgery & Microsurgery.

Complex Carpal Instability

What is carpal instability ?

The bones of the wrist joint are known as carpal bones. There are 8 carpal bones which are held together by ligaments.Ligaments help to keep the bones in position when the wrist joint moves or when a force is applied in the wrist. The complex articulation gives flexibility to the wrist and the wide range of movements. Wrist is one of the most commonly used and loaded joints. Hence it is prone to injuries especially when a person falls on outstretched hands.

The ligament injury may be limited to between two bones ( Eg : Scapho lunate ligament injury ) or it may involve multiple bones ( Eg : Perilunate injuries ). The ligament injury may be associated with bone fractures too (Eg : Transscaphoid perilunate injuries)

Complex carpal instabilities occur when there are multiple ligament injuries or associated fractures in the wrist. Injuries to multiple ligaments and fractures may lead to failure of the loading mechanism and can cause pain and disability to patients.

How is carpal instability treated ?

Carpal instabilities are severe injuries. They are managed by doctors who are specially trained in that. The functional outcome following such injuries depends on early successful repair.

Treatment involves immediate attempt of reduction of joints in the emergency department followed by surgery. Surgery involves repair of ligaments and fixation of carpal bones with screws or wires. Your doctor will apply a plaster. You will be encouraged to move your fingers , elbow and shoulder. X ray will be done immediately after surgery. Follow up x rays will be done every 4 or 6 weeks depending on the injury. How long you will have plaster , will depend on your injury.

What are the prognosis following carpal instability ?

Carpal instability needs emergency management. Many studies have sited that a delay of one week can result in loss of >50% of function of wrist. Functional results are often gratifying for patients, if done on time.