ABSTRACT
Background: Triangular fibrocartilage complex (TFCC) tears are a major source of ulnar-sided wrist pain and may result in patient disability, ranging from activities of daily living to high-level athletics. The purpose of this study is to evaluate the long-term clinical outcomes in patients affected by TFCC lesion and in association with or without distal radio ulnar joint (DRUJ) instability after arthroscopic repair. Methods: Younger patients (50 years of age or younger), presented with mechanical symptoms at least 6 weeks of failed conservative treatment, a positive, fovea! tenderness test, were included in the study. Patients were excluded if they had ulnar impaction syndrome, arthritis of wrist joint or other wrist pathology on arthroscopic examination. Final results were evaluated after 1 year. Results: Forty-nine wrists in 48 patients had arthroscopy for a possibly repairable peripheral TFCC tear during the study period. Thirty four wrists in 34 patients remained after exclusions. The Mayo score from pre-operative value 46.9±10.4 was increased to 91.7±5.0 postoperatively. At final follow-up, 2 patients had fovea! tenderness, and no patients had a piano-key sign or caput ulna. Conclusion: Arthroscopic repair for traumatic TFCC fovea! tear can restore stability to the DRUJ and provide satisfactory subjective and objective results without serious complications after more than 12 months' follow-up.
ABSTRACT
Background: Treatment of humeral shaft fractures continues to evolve as advances are made in both non-operative and operative management. The encouraging results that have been reported with recent advances in internal fixation techniques and instrumentation. The controversy still exist between plating and intramedullary nailing. MIPO (Minimal invasive plate osteosynthesis) has emerged as a new alternative mode or treatment. In this study, we compare the result of MIPO and intramedullary nailing. Methods: This was an institution based, prospective longitudinal and comparative study. Patients of age of 20 to 60 years (skeletally mature) which required operative intervention in this study. Pathological fractures, segmental fractures, neurovascular injury were excluded. Patients were followed for at least one year. Results: 130 patients were included in this study. Intramedullary nailing was done in 60 patients and MIPO plating done in 70 pts. Demographically, there was no difference between the groups. No statistical difference was found regarding union and complication. There was significant statistical difference of UCLA shoulder score between the groups. But no difference in Mayo elbow performance score. Discussion: This study shows that the MIPPO technique is safe, convenient and effective, since there was a minimal soft tissue injury and no major complications. It does not disturb the fracture hematoma like open plating and thus help in fracture union. There is no injury to the rotator cuff or supraspinatus tendon like intramedullary nailing in MIPO plating. Conclusion: MIPO is a modality which results in a relatively stable fracture construct while preserving a biologic environment that facilitates rapid bone healing without disturbing rotator cuff.