Acute Static Volar Intercalated Segment Instability (VISI) of the Wrist: A Case Report
|Panagopoulos A1*, Allom R2 and Compson J2|
|1Department of Upper Limb Surgery and Reconstruction, Patras University Hospital, Greece|
|2Upper Limb Unit, Orthopaedic Department, King’s College Hospital, London, UK|
|Corresponding Author :||Andreas Panagopoulos
Lecturer in Orthopaedics
Department of Upper Limb Surgery and Reconstruction
Patras University Hospital
Papanikolaou str, 26504 Rio-Patras, Greece
E-mail: [email protected]
|Received May 18, 2013; Accepted August 08, 2013; Published August 12, 2013|
|Citation: Panagopoulos A, Allom R, Compson J (2013) Acute Static Volar Intercalated Segment Instability (VISI) of the Wrist: A Case Report. J Med Diagn Meth 2:129. doi:10.4172/2168-9784.1000129|
|Copyright: © 2013 Panagopoulos A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Introduction: Isolated injuries of the lunotriquetral (LTq) interosseous ligament and associated structures are less common and less well understood than other forms of dissociative carpal instability. For a VISI deformity to occur the LTq interosseous ligament must be disrupted but the progression of lunotriquetral dissociation requires further ligamentous injury, particularly the palmar LTq ligament, and for full dissociation between the lunate and triquetrum, the dorsal radiocarpal ligaments, which finally results in a static volar intercalated segmental instability (VISI) pattern.
Case report: A 52-year old left-handed male patient of black origin was presented with a rare pattern of an acute static volar intercalated instability (VISI). Complete disruption of both the intrinsic lunotriquetral ligaments and the dorsal intercarpal ligaments were identified at surgery. Direct repair and dorsal capsulodesis plus temporary pinning of the lunotriquetral joint were carried out. The patient had a good clinical outcome at 2.5 years of follow up despite the persistent static VISI deformity in the last follow up radiographs.
Conclusion: This case represents a clinical proof of both anatomical and biomechanical studies that in order for a static VISI deformity to occur (Stage III), not only must the lunotriquetral interosseous ligament and the palmar lunotriquetral ligaments be disrupted but there must also be disruption to the dorsal capsule.