A case of acute lunotriquetral dissociation with static volar intercalated segment instability

Abstract

A 58-year-old man developed lunotriquetral dissociation with static volar intercalated segment instability (VISI) by a mechanism of hyperflexion of the dorsum during a fall on his left wrist. Wrist motion was greatly restricted. He refused open reduction, and was treated with closed reduction and capitolunate external fixation under axillary block anesthesia and continuous traction. The postoperative course was uneventful, and the fixator was removed after eight weeks. However, radiographs obtained four weeks after the removal of the fixator revealed recurrence of the deformity, at a time when the patient was completely asymptomatic. On clinical examination, there was no difference between the grip strengths of the hands. Compared to the normal side, the ranges of flexion, extension, and radial deviation of the left wrist were decreased, but there was an increase of 5° in the range of ulnar deviation. The presented case has several unique features, including the acute form of lunotriquetral dissociation with VISI deformity, mechanism of injury, the reduction technique, and the development of recurrence when the patient was fully asymptomatic.