Volar intercalated segmental instability

Dr Craig Hacking and Dr Maxime St-Amant et al.

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 any lateral or sagittal imaging of the wrist when the wrist is in a neutral position:

The mainstay of treatment is surgery, either by early reduction and casting with K-wires or by capitolunate fusion.

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Article information

rID: 21511
Tag: cases, wrist
Synonyms or Alternate Spellings:
  • VISI
  • VISI deformity
  • VISI configuration
  • Volar intercalated segmental instability (VISI)

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Cases and figures

  • Figure 1
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  • Case 1: with concurrent Kienbock disease
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  • Figure 2
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  • Figure 3
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  • Case 2: VISI, lunotriquetral ligament rupture
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