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Online ISSN 1827-1707
G. C. Kantunakis, A. Russomando, A. Marcuzzi
Struttura Complessa di Chirurgia della Mano, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italia
Wrist dysfunction, resulting from ligament injuries, has for a long time interested the specialist in hand surgery and even if in the last three decades many laboratory and clinical researches have been performed, many aspects of these subjects remain unknown or poorly understood. The first authors who describe carpal instability were Linscheid and Dobyns. A wrist must be considered unstable when the normal relationship between the carpal bones is not preserved. Carpal instability is a difficult classifying syndrome. Many different clinical conditions may result in an unstable wrist so different classifications have been proposed. Some authors classify instability according to its severity (dynamic, predynamic, static); others on the timing of lesion (chronic, acute, sub-acute), others emphasize the direction of the abnormal alignment or the location of the main ligament involved. Even if the classification often is not able to describe the complexity of the clinical and pathomechanical pictures, the knowledge of the classification is important to reach a correct diagnosis and an adeguate surgical treatment. In fact the main problem related to carpal instability in medical practice is a delayed diagnosis at the time that complications of the disease (ostheoartrhritis, carpal collapse) are already at an advanced stage. This article introduces a general description and classification of carpal instability and the main guide-lines of diagnosis and treatment.