Management of a Missed Dorsal Radiocarpal Ligament Avulsion Fracture

Abstract Volar intercalated segment instability (VISI), a type of carpal instability non-dissociative (CIND), is an abnormal wrist kinematics resulting from extrinsic ligament injury. It is a rarely reported sequela of distal radius fractures, often involving damage to the dorsal radiocarpal (DRC) ligament. If untreated, this condition can progress to debilitating midcarpal instability, chronic pain, and limited range of motion. This article presents a case of a missed DRC ligament avulsion fracture following a volar Barton distal radius fracture, which progressed to a CIND-VISI deformity. Early surgical intervention with dorsal capsular repair achieved an excellent functional outcome. Existing literature on this condition comprises only a few case reports and small series. Injuries to the DRC ligament following distal radius fractures are frequently missed at initial presentation. Management strategies described in these reports include open reduction, ligament repair, or salvage procedures. This report highlights a typical yet under-recognized presentation of a DRC ligament avulsion. It underscores the critical importance of diagnosing and managing this injury promptly to prevent the development of a CIND-VISI deformity. V.