Linscheid et al. describe the radiographic landmarks, classification, and mechanical basis of traumatic carpal instability across 47 wrists. The paper asks: what are normal intercarpal angular relationships, how do they break down after ligament or bone disruption, and how should the resulting collapse patterns be classified? This is the founding paper for DISI and VISI.
Any wrist injury with a scapholunate gap >2 mm on PA or a scapholunate angle >70° on lateral is DISI until proven otherwise. Those two numbers are your screening thresholds — write them on a flashcard.
Check the lateral radiograph on every wrist trauma, even when the PA looks benign. The paper makes explicit that intercarpal collapse on the lateral predicts both non-union and eventual degenerative arthritis, and that this pattern is underrecognized.
When closed reduction fails to fully correct the collapse, this paper's authors advocate open reduction and internal fixation. The argument is biomechanical: an unreduced intercalated segment will continue to collapse under axial load.
The finding that both the scapholunate interosseous ligament and the palmar radiocarpal ligament must be torn to produce full DISI explains why partial injuries can present with a widened gap but preserved scapholunate angle. A subtlety worth knowing when counseling patients about the spectrum of injury severity.
This paper is the foundation for SLAC wrist staging: the degenerative sequence Linscheid predicted from unrecognized carpal instability was later formalized by Watson and Ballet (1984), but the mechanistic warning is explicit here in 1972.
Linscheid et al. describe the radiographic landmarks, classification, and mechanical basis of traumatic carpal instability across 47 wrists. The paper asks: what are normal intercarpal angular relationships, how do they break down after ligament or bone disruption, and how should the resulting collapse patterns be classified? This is the founding paper for DISI and VISI.
Any wrist injury with a scapholunate gap >2 mm on PA or a scapholunate angle >70° on lateral is DISI until proven otherwise. Those two numbers are your screening thresholds — write them on a flashcard.
Check the lateral radiograph on every wrist trauma, even when the PA looks benign. The paper makes explicit that intercarpal collapse on the lateral predicts both non-union and eventual degenerative arthritis, and that this pattern is underrecognized.
When closed reduction fails to fully correct the collapse, this paper's authors advocate open reduction and internal fixation. The argument is biomechanical: an unreduced intercalated segment will continue to collapse under axial load.
The finding that both the scapholunate interosseous ligament and the palmar radiocarpal ligament must be torn to produce full DISI explains why partial injuries can present with a widened gap but preserved scapholunate angle. A subtlety worth knowing when counseling patients about the spectrum of injury severity.
This paper is the foundation for SLAC wrist staging: the degenerative sequence Linscheid predicted from unrecognized carpal instability was later formalized by Watson and Ballet (1984), but the mechanistic warning is explicit here in 1972.