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