1

Scapholunate dissociation (early stages)

2

Lunotriquetral dissociation (early stages)

3

Axial dislocations of the carpus (if neither carpometacarpal joints distally nor proximal carpal row joints proximally are involved)

3A

Axial radial

 Peritrapezoid, peritrapezium, transtrapezium

3B

Axial ulnar

 Transhamate/peripisiform, perihamate/peripisiform, perihamate/transtriquetrum

CIND (DISI or VISI pattern or ‘translatory’ patterns)

1

Radiocarpal

 Dorsal or volar Barton’s fracture/dislocation

 Distal radius malunion (if extrinsic ligament damage is present or develops)

 Rupture of radiocarpal extrinsic ligaments (all ruptured equals radiocarpal dislocation; total or partial rupture can result in VISI, DISI, UT, DT, or VT)

 Radioscaphocapitate

 Short radiolunate

 Long radiolunate

 Ulnocapitate

 Ulnotriquetral

 Madelung’s deformity (may occur with sufficient ulnar deformity)

 Ulnar translocation of the carpus

 Radiocarpal dislocation

 CLIP (if proximal instability present; the major instability in CLIP is the mid-carpal level instability) Proximal carpal row instability due to radiocarpal level damage only

2

Mid-carpal

 Proximal carpal row instability due to mid-carpal level damage only (the MCI of the literature)—a VISI deformity

 CLIP: the characteristic dorsal subluxation of the distal carpal row is due to damage at this level—a DISI deformity

CIC

1

Any of the perilunate to lunate dislocation spectrum

 Dorsal and volar perilunate to lunate dislocations (ligamentous)

 Transosseous perilunate variants

 Trans-scaphoid dorsal perilunate and others

2

Any combination of two or more CID or CIND instabilities

3

CID which develops extrinsic ligament or additional intrinsic ligament insufficiency, i.e. stage 3 SLD with DISI

4

CIND which develops intrinsic ligament or additional extrinsic ligament insufficiency, i.e. proximal carpal row instability (either DISI or VISI) with extrinsic ligament damage at both radiocarpal and mid-carpal levels

CIA

1

Any adaptive or apparent adaptive posture of the carpus not based on carpal injury, but reflecting changes in forearm or hand support structures

 Apparent CIND-DISI with a dorsiflexion malunion of a distal radius fracture (Colles type)

 Apparent CIND-VISI with a volar flexion malunion of a distal radius fracture (Smith type)

 Madelung’s deformity with hypoplasia of the ulnar radius and displacement of the distal ulna