Arthroscopic management of triangular fibrocartilage complex [tfcc] injuries

Background: Triangular fibrocartilage complex [TFCC] injury is major cause of ulnar side wrist pain. It can lead to distal radio ulnar joint instability

Aim of the work: was to examine the efficacy of arthroscopic management of the TFCC injuries, and assess the functional outcome of this procedure

Patients and Methods: Twenty patients with torn TFCC underwent arthroscopic management. Five patients had central TFCC tears to which arthroscopic debridement was done. Five patients had superficial peripheral TFCC tears to which arthroscopic reattachment to the capsule was done. Ten patients had deep foveal TFCC tears with DRUJ instability to which arthroscopic assisted foveal reattachment by suture anchor was done. All patients were assessed before and after surgery [at follow-up] by Visual Analogue Scale [VAS] for pain, the Disability of the Arm, Shoulder and Hand [DASH] score, the Modified Mayo Wrist Score [MMWS], and the incidence of complications

Results: Twenty patients were available for follow-up at a mean of 12.9 months. VAS improved from a mean of 6 to a mean of 1.3 [p<0.001]. The DASH score improved from a mean of 28.2 to a mean of 5.8 [P < 0.001]. MMWS improved from a mean of 66.3 to a mean of 88.5 [p<0.001]

Conclusion: Arthroscopic management of TFCC tears has shown to reach good results according with different TFCC lesions and improvement in pain and function. However, the current study is limited by absence of conservative or open control group for comparison and the relatively short follow-up period

Evaluation of the accuracy of trigger finger injection using ultrasound

Background: Trigger finger is a common cause of disability and pain in the hand and The lines of management of this disease start by conservative treatment as rest, NSAID, local corticosteroid injection under the tendon sheath either blind or by musculoskeletal ultrasound guidance and surgery may indicated in recurrent cases

Aim of the study: The aim of the present study was to evaluate the musculoskeletal ultrasound accuracy to guide the injection of corticosteroid in trigger finger management

Material and methods: 50 cases that complaint from symptoms of trigger digit in this randomized, prospective control study were recorded. All the cases were injected by 1 ml corticosteroid 1ml of 2% lidocaine at the level of the A1 pulley under the tendon sheath. The injection done under control of musculoskeletal ultrasound after a blinded needle insertion. Comorbidities and associated diseases were recorded. Follow up examinations at the 2 week and 6 months, no complications were recorded. The results were assessed according to the green's grading. The pain was assessed according to visual analogue scale

Results: The cases in the present study were assessed according to age, associated diseases and hand dominance. The female patients were more than male patients in the present study. The injection under control of musculoskeletal ultrasound accurate more than a blinded injection even when an expert physician who did it. And It showed the same efficacy according to green's grading at the period of follow up examinations when compared with the pre-injection status. No complications were seen during the period of the follow up

Conclusion: A different technique of injection using musculoskeletal ultrasound guidance all of which gave excellent accuracy superior to a blinded injection even when it is done by expert physician. However, the post injection result was similar to that of a blinded injection. Level one of evidence [randomized prospective study]

Supracondylar femoral flexion osteotomy for genu recurvatum after poliomyelitis, a modified technique

Twenty-one patients with genu recurvatum had femoral flexion osteotomy. Patients were divided into 2 group; the first group included patients below 12 years old, while the second group included those above 12 years. Thirteen patients of the first group had two stage supracondylar femoral flexion osteotomy. The second group were adult patients with severe deformity with one stage supracondylar osteotomy and fixation using ilizarov external fixation. The deformity was corrected by callus distraction technique [Imm/day] after two weeks of compression. After a mean follow up of 38 month, both groups had good to excellent function outcome with improvement of the gait and discard orthosis. All patients were satisfied with no recurrence