Volar intercalated segmental instability (VISI) is a type of instability involving the wrist. It is less often encountered than dorsal intercalated segmental instability (DISI).
It presents in most cases with nonspecific wrist pain and a "clunking" on the ulnar deviation of the wrist.
VISI can occur because of a disruption of radiocarpal ligaments on the ulnar side of the wrist. The main ligaments involved in this instability are thought to be the ulnar half of the volar arcuate ligament 6 and the lunotriquetral ligament 6,7. It may be static or dynamic.
The main radiographic features are a volar rotation of the lunate and dorsal rotation of the capitate and hamate.
Abnormal carpal angles are seen on a lateral wrist x-ray:
Treatment and prognosis
The mainstay of treatment is surgery, either by early reduction and casting with K-wires or by capitolunate fusion.
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