CARPAL INSTABILITY NONDISSOCIATIVE

A retrospective study of 45 patients with symptoms of wrist pain and w eakness with clinical evidence of instability is presented. These pati ents had normal intrinsic interosseous ligaments demonstrated arthrogr aphically or surgically. They were followed for a minimum of 18 months and an average of 5.8 years. All patients demonstrated instability of the proximal carpal row which is referred to as carpal instability no n-dissociative (CIND). Seven patients were treated non-operatively and 38 were treated operatively. Surgical management consisted of soft ti ssue reconstruction directed at the area of instability in 34 cases, j oint levelling osteotomy in six, three of whom also had soft tissue re constructions, and mid-carpal fusion in one. The overall good and exce llent results were a disappointing 56% and there was no significant di fference between the non-surgical and surgical groups. The best result s were found in the ulna-minus CIND patients who underwent a joint lev elling osteotomy, with 83% good and excellent results. CIND is associa ted with extrinsic ligamentous laxity; however, significant difficulty exists in locating the precise areas of maximum pathology. This accou nts for the unpredictable results of treatment. As our understanding o f the pathomechanics of CIND improves, the treatment will become more specific and the results should improve.