Volar intercalated segmental instability (VISI)

Case contributed by Bahman Rasuli
Diagnosis almost certain


History of distal radius fracture a year ago. Now referred with Intermittent chronic wrist pain.

Patient Data

Age: 30 years
Gender: Male
  • the lunate is volar tilted with an increased capitolunate angle measuring about 37o (normal <30o) and decreased scapholunate angle measuring about 26o (normal: 30o - 60o) suggesting volar intercalated segment instability (VISI)

  • malunion distal radius fracture with intraarticular extension

  • mild effusion at distal radioulnar joint

Case Discussion

MRI features are in keeping with chronic distal radius malunion fracture with misalignment of the radius-lunate-capitate axis resultant volar intercalated segment instability (VISI).

Volar intercalated segment instability (VISI) is a type of carpal instability featuring volar tilt of the lunate. It is less often encountered than dorsal intercalated segment instability (DISI).

The scapholunate angle in a normal situation on the sagittal imaging of the wrist is between 30 and 60°.

The capitolunate angle in a normal situation on the sagittal imaging of the wrist is less than 30°.

In volar intercalated segmental instability, we will see an increase in capitolunate angle and a decrease in the scapholunate angle.

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