Young patient with carpal instability [Helio Polido Garcia - 2019]

Young patient with carpal instability [Helio Polido Garcia - 2019]


Young Patient with carpal instability 

Dear colleagues
I need your help with a totaly atypical carpal instability in a very young male
I would appreciate very much your attention and opinion
Attached is the case summary

Thank you very much!!

Hélio Polido

 


 

 I don´t think this is a posttraumatic wrist disease. It looks like systemic problém, my suspition would be some kind of HLA B 27 positive trouble or parainfection reactive artritis. Reiter??? There are changes in CMC area and after trauma (if not infected) you don´t see changes there. My approach would be firts find out why this happened and then just wait and see ev. denervation or synovectomy??? It will finish with stiff wrist anyway but you have  to know why.

 Radek Kebrle
Czech Republic

 

 

It looks like a volar midcarpal instability… But I don’t understand so fast destruction…infection but why ? The situation is critical. The arthroscopic capitate/hamate resection won’t work. I suggest you to perform, only iof he is really painful a partial arthrodesis (hamato, capito,triquetro,  luno, scaphoid) with distal scaphoid resection. If you operate on him, don’t forget to make anatomopathological exam

Christophe Mathoulin
France

 

Dear Helio,
I also think it’s a systemic disease. IN MRI especially n radial side we see a lot of synovitis.
Ask the radiologist again for systemic disease. DO you have any blood samples for /against RA?
If so, he need some medical treatment, but anyway I think he need a midcarpal fusion.

 

Eva-Maria Baur

 

Dear Helio,
I have seen a few cases with that problem, and it was usually related to juvenile rheumatoid arthritis, which progresses rapidly. I would therefore scope and take a specimen for histopathology and check if the radius/lunate cartilage is still viable and intact.

Sebastian Farr

 

 

For me it is an arthritis case, not a trauma. All the joint are involved. Even carpometacarpal one.

Igor Golubev

 

Looks to me , more of an erosive arthropathy than a post traumatic osteoarthritis. Hx of trauma might be a red herring.

Melanie A

 

It is not a post traumatic problem. This young patient needs a complete examination (rheumatologist, ophthalmologist) before any surgery  It will probably be useful to perform arthroscopic biopsy with anatomopathology exam and bacteriology

Dominique Blancke
France

 

Thank you very much for all opinions. Very helpful. I’ll work on that and keep close to rheumatologist 

Hélio Polido Garcia

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