Ibitayo Ayooluwa, Beckmann Nicholas M
School of Medicine, St George's University, St George's, West Indies, Grenada.
Department of Diagnostic and Interventional Imaging, University of Texas McGovern Medical School, 6431 Fannin Street, 2.130B, Houston, TX, 77030, USA.
Emerg Radiol. 2021 Apr;28(2):349-359. doi: 10.1007/s10140-020-01839-5. Epub 2020 Aug 18.
To review the epidemiology, pertinent wrist anatomy, classification system, and emergent imaging evaluation of carpal instability with a focus on radiographic assessment of instability.
A review of current literature on carpal instability was performed with summary presentation of carpal instability epidemiology, carpal anatomy, imaging evaluation, and classification with imaging evaluation focused on diagnosis in the emergency setting.
Carpal instability is a common pathology in falls on outstretched hand and is likely underdiagnosed due to instability being occult or demonstrating subtle malalignment on static imaging of the wrist. While there is a complex network of intrinsic and extrinsic ligaments contributing to carpal instability, a detailed knowledge of these ligaments is not necessary for radiologists to make an accurate diagnosis in the emergency setting, as identification and classification of carpal instability is based on identification of carpal malalignment patterns on radiography as opposed to identification of specific ligament injuries on advanced imaging. The Mayo classification is the most widely used classification system, which divides carpal instability into four categories: dissociative, non-dissociative, complex, and adaptive. Understanding this classification system allows radiologists to successfully classify almost all carpal instability injuries they will encounter, even in the setting of unusual or rare instability patterns.
In working with the treating clinician, it is essential that the emergency radiologist is comfortable with identifying and classifying carpal instability. This will ensure prompt treatment of seemingly benign injuries and those that require intervention, surgical or otherwise, improving the likelihood of a good outcome.
回顾腕关节不稳定的流行病学、相关腕部解剖结构、分类系统及紧急影像学评估，重点关注不稳定的X线评估。
对当前有关腕关节不稳定的文献进行综述，总结腕关节不稳定的流行病学、腕部解剖结构、影像学评估及分类，影像学评估重点在于急诊情况下的诊断。
腕关节不稳定是伸直手着地跌倒时的常见病理情况，由于不稳定情况隐匿或在腕关节静态成像时显示细微排列不齐，可能存在漏诊。虽然存在复杂的内在和外在韧带网络导致腕关节不稳定，但放射科医生在急诊情况下进行准确诊断并不需要详细了解这些韧带，因为腕关节不稳定的识别和分类是基于X线片上腕骨排列不齐模式的识别，而非基于高级成像上特定韧带损伤的识别。梅奥分类是使用最广泛的分类系统，它将腕关节不稳定分为四类：分离性、非分离性、复杂性和适应性。理解这一分类系统能使放射科医生成功对几乎所有他们会遇到的腕关节不稳定损伤进行分类，即使在出现不寻常或罕见的不稳定模式时也是如此。
在与主治临床医生合作时，急诊放射科医生必须熟练掌握腕关节不稳定的识别和分类。这将确保对看似良性的损伤以及那些需要手术或其他干预的损伤进行及时治疗，提高获得良好预后的可能性。
