Modified Palmer classification of traumatic triangular fibrocartilage complex injury based on MRI / 实用放射学杂志

Objective To classify traumatic triangular fibrocartilage complex(TFCC)injury based on 3.0T MR.Methods A total of 46 patients with definite history of wrist trauma admitted were collected.All patients underwent MRI scanning within 3 days after trauma,and the MRI findings were classified as follows according to the Palmer classification criteria:the focal structures of triangular fibro-cartilage(articular disc)(TFC)injury,the horizontal of the articular disc tear,injuries of ulnar styloid attachment and ulnar fovea attach-ment in TFC,ulnolunate and ulnotriquetral ligaments injuries,injury of the radial sigmoid notch junction,meniscal homologous inju-ry.The presence of TFCC injury was eventually confirmed by surgery in all patients.Results Of 46 patients,38 patients could be classified by Palmer,and there were 10 cases with type ⅠA,23 cases with type ⅠB,3 cases with type ⅠC and 2 cases with type ⅠD.A total of 8 patients were not suitable for Palmer type,and there were 3 patients with horizontal tears in the articular disc and 5 patients with meniscus homologous injuries.Conclusion The 3.0T MR can not only show various subtypes of Palmer classification,but also refine and supplement the classification based on the original classification,such as the injuries of ulnar styloid attachment and ulnar fovea attachment at the ulnar end of the articular disc,horizontal tear of the articular disc,meniscus homologous injury,etc.

Concomitant Ulnar Styloid Fractures in Distal Radius Osteosynthesis Does Not Impact Radiographic Outcomes, Ulnar Sided Symptoms and Patient Outcomes

@#Introduction: Current literature reports varied significance of ulnar styloid fractures (USF) associated with distal radius fractures. Our study assesses the role of ulnar styloid fractures and fragment size in surgically managed distal radius fractures. Materials and methods: We reviewed patients who underwent surgical fixation of distal radius fractures between January 2004 to June 2006. Patients were divided into those with (Group 1) and without (Group 0) USFs. Post-operative radiographic parameters, clinical outcomes and overall wrist function were analysed. Outcomes included ulnar-sided wrist pain, extensor carpi ulnaris (ECU) tendinitis, triangular fibrocartilage complex (TFCC) grind test, distal radioulnar joint (DRUJ) instability and pain. Overall wrist function was assessed with range of motion and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results: Our study cohort included 31 males and 23 females, and 38.9% of these patients had concomitant USFs. There was no difference in terms of demographic data and fracture configuration between groups. Radiographic parameters were similar, except for palmar tilt, which was significantly higher in Group 1 (4.6º vs 9.4º, p=0.047). At 24 months, there were no differences in clinical outcomes and overall wrist function. A sub-group analysis showed that mean USF fragment size was larger in patients with a positive TFCC grind test (3.9mm vs 7.3mm, p=0.033). Conclusion: The presence of USFs in surgically managed distal radius fractures does not compromise clinical and functional outcome. Similarly, the size of USFs does not impact clinical and functional outcome but is associated with the presence of a positive TFCC grind test.

Efficacy of wrist arthroscopic transosseous footprint repair technique for the treatment of triangular fibrocartilage complex injury / 中华创伤杂志

Objective:To investigate the clinical efficacy of wrist arthroscopic transosseous footprint repair technique for treating triangular fibrocartilage complex (TFCC) injury.Methods:A retrospective case series study was conducted to analyze the clinical data of 56 patients with TFCC injury admitted to Shenzhen Second People′s Hospital from July 2017 to September 2020, including 38 males and 18 females, aged 17-45 years [(33.5±3.6)years]. All patients had unilateral injury. Physical examination showed instability of the distal radioulnar joint, and MRI and arthroscopy confirmed deep ligament injury of TFCC. All patients underwent repair of deep insertion of the TFCC by using wrist arthroscopic transosseous footprint. The operation time, intraoperative blood loss, wound healing and postoperative complications were recorded. The flexion and extension range of motion of the wrist, radial and ulnal deviation of the wrist, rotation range of motion of the forearm, patient related wrist evaluation (PRWE) score, modified Mayo wrist score, visual analogue scale (VAS), and percentage of grip strength between the affected side and unaffected side were compared preoperatively, at 3 months postoperatively and at 1 year postoperatively.Results:All patients were followed up for 12-18 months [(13.4±5.2)months]. The operation time was (61.3±8.9)minutes, with the intraoperative blood loss of (2.4±1.2)ml. All wounds were healed by first intension. There was no wound infection or ulnar nerve irritation symptom after operation. Four patients experienced clicking on the ulnar side of the wrist in a short period of time post-operation, with spontaneous disappearance of the symptom. At 3 months postoperatively, the radial and ulnar deviation of the wrist was decreased from (52.5±5.9)° preoperatively to (42.6±5.9)°, and rotation range of motion of the forearm was decreased from (94.9±8.4)°preoperatively to (84.6±5.9)° (all P<0.01). The flexion and extension range of motion of the wrist was (93.1±17.4)° preoperatively, with insignificant difference compared with (89.4±5.8)° at 3 months postoperatively ( P>0.05). At 1 year postoperatively, the flexion and extension range of motion of the wrist, radial and ulnar deviation range of motion of the wrist, and rotation range of motion of the forearm were significantly increased to (101.3±13.6)°, (52.4±6.6)°, and (116.4±16.4)° when compared with those at 3 months postoperatively (all P<0.01). At 3 months postoperatively, the PRWE score was increased to (17.1±3.8)points from (10.6±3.2)points preoperatively ( P<0.01), modified Mayo wrist score was decreased to (70.3±6.7) points from (78.1±12.7)points preoperatively ( P<0.01), VAS was decreased to (4.4±1.7)points from (6.2±1.5)points preoperatively ( P>0.05), and percentage of grip strength between the affected side and unaffected side was decreased to (55.7±8.7)% from (74.4±15.2)% preoperatively ( P<0.01). At 1 year postoperatively, the PRWE score was increased to (2.0±0.9)points, modified Mayo wrist score was increased to (94.8±3.3)points, VAS was decreased to (2.1±1.1)points, and percentage of grip strength between the affected side and unaffected side was increased to (93.2±8.7)% when compared with those at 3 months postoperatively (all P<0.01). Conclusion:Wrist arthroscopic transosseous footprint repair technique can effectively treat deep ligament injury of TFCC, with advantages of significantly improving postoperative joint range of motion and functional score, relieving the pain on the ulnar side of the wrist and enhancing grip strength.

Correlation between distal radioulnar joint effusion and the integrity of triangular fibrocartilage in healthy young adults / 中华全科医师杂志

Objective:To study the relationship between distal radioulnar joint (DRUJ) effusion and the integrity of triangular fibrcarotilage (TFC) in asymptomatic young adults.Methods:Thirty two asymptomatic young adults, 22 males and 10 females with a mean age of 25 year(20-30) were recruited in the study between September 2014 and October 2019. All subjects had no wrist pain, no wrist deformity or wrist mass, and had no history of wrist trauma or surgery. The DRUJ effusion was definedasfluid-like high signal intensityon fatsuppression proton density-weighted MRI.The presence of distal radioulnar joint effusion, the shape of the effusion, and the presence of triangular fibrocartilage abnormalities were documented.Results:Among 32 subjects, 25(78.1%, 15 males and 10 females) presented with distal radioulnar joint effusion on wrist MR images, including linear/tubular in 21 cases(84.0%) and saccular in 4 cases(16.0%).Twenty cases (62.5%) had distal radioulnar joint effusion while the TFC was intact, among whom, the effusion was confined to the proximal side of distal radioulnar jointin 17 cases, and reached the lower surface of TFC in 3 cases. In 5 cases (15.6%) with TFC tear, the effusion reached the lower surface of TFC in 4 cases. There were neutral, positive and negative variations of the ulna in 23, 6 and 3 cases, respectively, among whomthe distal radioulnar effusion was presented in 17, 5, 3 cases, and TFC tear in 1, 4 and 0 cases, respectively.The presence of distal radioulnar effusion was not significantly correlated with genders( P=0.069) or types of ulna variance( P=0.702). Conclusion:The distal radioulnar joint effusion maybe resent in asymptomatic young adults, and it maybe complicated with TFC tear.

Observation of short-term clinical efficacy of wrist arthroscopy in the treatment of Palmer ⅠB triangular fibrocartilage complex injury / 中国基层医药

Objective To observe the short-term clinical efficacy of wrist arthroscopy in the treatment of Palmer ⅠB type triangular fibrocartilage complex ( TFCC) injury.Methods From March 2016 to January 2017, 12 patients with Palmer ⅠB TFCC were admitted to the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,including 5 males and 7 females,with an average age of 38.5 years.After examination and imaging exami-nation,the diagnosis was confirmed.After full preoperative preparation , the patients underwent arthroscopic repair under wrist arthroscopy.The VAS score and modified Mayo wrist joint function score before and after surgery were tested to evaluate the clinical efficacy after 6 months.Results Twelve patients underwent successful operation and with no postoperative complications.The patients were followed up.The VAS scores before and after surgery were (4.08 ±0.90)points and (1.33 ±0.88)points,respectively,the difference was statistically significant (t＝8.37,P＝0.000).The modified Mayo wrist joint function scores were (48.33 ±7.48)points and (87.91 ±5.41)points before and after surgery,and the difference was statistically significant ( t＝12.05,P＝0.000).Conclusion Arthroscopic repair of Palmer Ⅰb type TFCC has less trauma and quick recovery ,and the clinical short-term result is satisfactory.

Observation of short-term clinical efficacy of wrist arthroscopy in the treatment of Palmer IB triangular fibrocartilage complex injury / 中国基层医药

Objective@#To observe the short-term clinical efficacy of wrist arthroscopy in the treatment of Palmer IB type triangular fibrocartilage complex(TFCC) injury.@*Methods@#From March 2016 to January 2017, 12 patients with Palmer IB TFCC were admitted to the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, including 5 males and 7 females, with an average age of 38.5 years.After examination and imaging examination, the diagnosis was confirmed.After full preoperative preparation, the patients underwent arthroscopic repair under wrist arthroscopy.The VAS score and modified Mayo wrist joint function score before and after surgery were tested to evaluate the clinical efficacy after 6 months.@*Results@#Twelve patients underwent successful operation and with no postoperative complications.The patients were followed up.The VAS scores before and after surgery were (4.08±0.90)points and (1.33±0.88)points, respectively, the difference was statistically significant(t=8.37, P=0.000). The modified Mayo wrist joint function scores were (48.33±7.48)points and (87.91±5.41)points before and after surgery, and the difference was statistically significant(t=12.05, P=0.000).@*Conclusion@#Arthroscopic repair of Palmer IB type TFCC has less trauma and quick recovery, and the clinical short-term result is satisfactory.

Value of conventional wrist physical examination in detection of injury to triangular fibrocartilage complex / 中华创伤骨科杂志

Objective To evaluate conventional wrist physical examination in detecting injury to the triangular fibrocartilage complex (TFCC).Methods A retrospective study was conducted of the 118 patients (119 wrists) who had been admitted from January 2013 to October 2017 to Hand Surgery Department,Beijing Jishuitan Hospital for wrist arthroscopic surgery.All of them underwent wrist physical examination preoperatively for conventional index tests for TFCC injury like ulnar fovea sign,piano-key test,distal ulnar ballottement test and ulnocarpal stress test.They were 68 males and 50 females with a mean age of 32 years.The results of physical examination were compared with the arthroscopic findings to calculate the sensitivity,specificity,positive/negative predictive value (PPV/NPV) and +/-likelihood ratio (LR) of each index test.In addition,we combined the results of any 2 tests to increase the capability of detecting peripheral TFCC injury.Results The diagnostic values of each index test were achieved by comparison between the results of physical examination and the arthroscopic findings:(1) ulnar fovea sign:sensitivity =0.648,specificity =0.742;(2) piano key test:sensitivity =0.817,specificity =0.735;(3) distal ulnar ballottement test:sensitivity =0.927,specificity =0.647;(4) ulnocarpal stress test:sensitivity =0.825,specificity =0.500.The combination of any 2 tests produced 3 new index tests,of which the most valuable combination was ulnar fovea sign & distal ulna ballottement test,with a sensitivity of 0.598,a specificity of 0.941,a PPV of 0.961and a + LR of 10.14,Conclusions The signs elicited in physical examination and special tests can be helpful in the diagnosis of TFCC injuries.However,as the value of any single test is not enough,we should clinically combine the results of ulna fovea sign and distal ulna ballottement test to increase the capability of detecting peripheral TFCC injury.

Nova técnica cirúrgica para Reconstrução da Articulação Radioulnar Distal em instabilidades crônicas sem Artrose / New technique for reconstruction of distal radialulnar joint in chronic instability without arthrosis

Desordens da articulação radioulnar distal (ARUD) de diferentes etiologias são relativamente comuns e podem afetar gravemente a função do punho e antebraço. As lesões agudas, se não identificadas e tratadas, podem evoluir com dor e instabilidade crônica e quadros degenerativos em estágios mais avançados. Devido a características ósseas locais, a estabilidade é dada principalmente pelas partes moles, sendo o complexo de fibrocartilagem triangular (CFCT) a principal estrutura. A restauração da estabilidade da ARUD é objetivo do tratamento e as reconstruções constituem o grupo principal quando se trata de lesões crônicas sem artrose. O objetivo deste trabalho é descrever uma técnica de tenoplastia com uma tira do tendão do músculo flexor ulnar do carpo (FUC), para reconstrução anatômica da ARUD, e demonstrar a estabilidade dorsal e volar e a manutenção da pronossupinação após a reconstrução. Foram selecionados 10 cadáveres frescos sem sinais de lesões ou cirurgias prévias nos membros superiores e a técnica cirúrgica foi aplicada em ambos os punhos, totalizando 20 reproduções realizadas pelo mesmo médico-cirurgião da mão. Imagens foram registradas em cada passo da técnica em cinco cadáveres e reproduções computadorizadas foram criadas a seguir. Após a utilização de um cadáver piloto, outros quatro cadáveres foram submetidos a testes para verificação da melhora das translações dorsal e volar sobre carga mensurada e da manutenção da amplitude de movimentos após o procedimento. A técnica do presente estudo apresenta diversas vantagens em relação aos procedimentos já descritos na literatura, pois constitui uma reconstrução do CFCT, que tenta reproduzir a anatomia mais próxima do normal. Isso permite ganho de estabilidade em plano sagital e coronal, sem a limitação do movimento de pronossupinação. Outras vantagens do trabalho incluem a realização de apenas dois túneis ósseos, permanência de uma tensão constante do enxerto, sem afrouxamento com o tempo, por se tratar de uma tenoplastia dinâmica, manutenção da função primária do FUC e menos necessidade de dissecção. A técnica descrita reconstrói o complexo ligamentar da articulação radioulnar distal com a utilização de menor número de túneis ósseos e a correção da incongruência nos planos frontal e sagital. Mostrou também a correção, em cadáveres, das translações dorsal e volar e amplitudes de movimentos preservadas após a sua realização, se

Disorders of the distal radioulnar joint (DRUJ) of different etiologies are relatively common and can severely affect wrist and forearm function. Acute lesions, if unidentified and treated, may evolve with chronic pain and instability, or degenerative disease in more advanced stages. Due to local bone characteristics, stability is mainly given by the soft tissues, among which the triangular fibrocartilage complex (TFCC) is the main structure. Restoration of DRUJ stability is the goal of treatment and the reconstructions constitute the main group when treating chronic non-arthritic lesions. The objective of this paper is to describe a new technique of tenoplasty using a strip of flexor carpi ulnaris (FCU) tendon, for anatomical reconstruction of the DRUJ and to show dorsal and volar stability and maintenance of prono-supination after reconstruction. Ten fresh cadavers without signs of lesions or previous surgeries in the upper limbs were selected and the surgical technique was applied to both wrists, totaling 20 reproductions performed by the same hand surgeon. Photographs and finite models were made in five cadavers detailing the most important points of each steps of technique. After one pilot cadaver, other four cadavers tests were made to show improvement of dorsal and volar translations and maintenance of range of motion after the procedure. The technique of this study presents several advantages when compared to the procedures already described in the literature, because it reconstructs the TFCC and brings anatomy closer to the normal. This allows gain of stability in the sagittal and coronal plane, without compromising range of motion. Other advantages of this study include performing only two bone tunnels, with reduced risk of iatrogenic fracture; maintaining a constant tension of the graft, without loosening over time, considering that it is a dynamic tenoplasty; conservation of the primary function of the FCU, without the need of an aggressive dissection. The technique reconstructs the DRUJ complex, with technical advantages over other described procedures, being a good alternative for the treatment of chronic instabilities of DRUJ without arthritis.

Wrist arthroscopy-assisted periosteal cleaning combined with articular capsule repair for type Ⅰ B triangle fibrocartilage complex lesions / 中华创伤杂志

Objective To evaluate the effect of wrist arthroscopy-assisted repair of stable or slightly unstable type Ⅰ B triangular fibrocartilage complex (TFCC) injury of distal radio-ulnar joint (DRUJ).Methods A retrospective case series study was conducted to analyze the clinical data of 42 patients with type Ⅰ B TFCC injuries admitted from May 2015 to August 2017,including 17 males and 25 females,aged 18-64 years,with an average of 38 years.Among the patients,20 were injured on the left side,and 22 on the right side.During the operation,if the injury was diagnosed as type Ⅰ B injury under wrist arthroscopy,outside in method with 3-0 purdis stitch was adopted to repair TFCC after joint cleaning.After the operation,the wrist joint was fixed in a neutral rotation position for 3 weeks with a long arm plaster over the elbow and then replaced with a short arm plaster for 2-3 weeks.Visual analogue scale (VAS),grip strength,joint mobility,modified Mayo wrist function score,and disabilities of arm,shoulder and hand score (DASH) before operation and at the last follow-up were compared.Results All patients were followed up for 6-24 months,with an average of 11 months.No infection or nerve injury occurred after operation.At the last follow up,wrist pain disappeared in 13 cases completely,while 29 cases still had pain during moderate activities.VAS was decreased from preoperative (2.7 ± 0.9) points to (1.2 ± 1.0) points (P ＜ 0.05).The grip strength was increased from preoperative (20.6 ± 8.3) kg to postoperative (22.5 ± 8.5) kg (P ＜ 0.05).The wrist flexion and extension,radial ulnar deviation,and forearm rotation were increased from preoperative (116.4 ± 26.0) °,(36.7 ± 10.7) °,and (137.9 ±29.1) ° to postoperative (119.4 ± 22.8) ° (P ＞ 0.05),(40.0 ± 10.6) ° (P ＜ 0.05),and (148.9 ±21.4) ° (P ＜ 0.05).The modified Mayo wrist function score increased from preoperative (67.3 ±9.6) points to postoperative (84.4 ± 6.7) points.The results were excellent in 13 cases,good in 24,and fair in five,with an excellent and good rate of 88％.The DASH score decreased from (34.6 ± 10.2)points to (10.4 ± 6.5) points after operation (P ＜ 0.05).Conclusion For patients with stable or slightly unstable type ⅠB TFCC injury of DRUJ,synovial membrane cleaning under wrist arthroscopy plus capsule repair combined with active rehabilitation training can effectively reduce wrist pain,and improve wrist radial ulnar deviation,forearm rotation and grip strength as well as improve wrist joint function.

Resultados de la reparación con sutura artroscópica de las lesiones periféricas cubitales del complejo fibrocartílago triangular (CFCT) (Palmer 1B/Atzei 1) / Arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears

INTRODUCCIÓN: Las Lesiones del Complejo Fibrocartílago Triangular (CFCT) son causa común de dolor Ulnar en la muñeca, la artroscopia es el estándar de oro para el diagnóstico y tratamiento de las mismas. Realizamos un trabajo retrospectivo evaluando la función y resultados de los pacientes operados con técnica artroscópica con la lesión CFCT Palmer 1B/Atzei 1. MATERIAL Y MÉTODO: Evaluamos 24 pacientes con 25 lesiones de CFCT palmer 1B/Atzei 1. El 88% en edad laboral entre 19 a 57 años (34 años promedio) con un seguimiento promedio de 9 meses. Todas las lesiones fueron reparadas con técnicas artroscópicas y puntos de sutura adentro afuera y afuera adentro. Se evaluó el Rango de Movilidad (ROM), fuerza de agarre, escala de Mayo de Muñeca y escala de DASH. RESULTADOS: Hemos tenido mejoras en test del dolor y la fuerza, el ROM promedio fue 70° para la extensión, 85° de flexión, 20° para la desviación radial y 30° de desviación cubital. El Score de muñeca de mayo fue excelente en el 64%, Bueno en el 16%, Satisfactorio en el 20% y no hemos tenido malos resultados. Nuestro Dash Score pre operatorio fue de 86 puntos y en el Post operatorio de 13 puntos. El promedio de la fuerza comparativa contralateral fue del 70%. CONCLUSIÓN: La reparación artroscópica de las lesiones Palmer 1B/ Atzei 1 dan resultados satisfactorios mejorando los ROM, recuperando la fuerza de forma total o parcial y disminuyendo el dolor. Encontramos que el tiempo entre la cirugía y los resultados obtenidos influye en los resultados y cuanto mayor es el seguimiento mejor los resultados. Tipo de estudio: Serie de casos. Nivel de evidencia: IV.

OBJECTIVE: Lesions of the Triangular Fibrocartilage Complex (CFCT) are a common cause of ulnar pain in the wrist; arthroscopy is the gold standard for the diagnosis and treatment of them. We performed a retrospective study evaluating the function and results of patients operated with an arthroscopic technique with Palmer 1B / Atzei 1 lesion. MATERIAL AND METHODS: We evaluated 24 patients with 25 CFCT lesions palmer 1B / Atzei 1. 88% of working age between 19 to 57 years old (average 34 years) with a follow-up of 9 months. All injuries were repaired with arthroscopic techniques and stitches inside and outside inside. The Mobility Range (ROM), grip strength, May Wrist score and the DASH Score were evaluated. RESULTS: We have had improvements in pain and strength tests, the average ROM was 70 ° for extension, 85 ° for flexion, 20° for radial deviation and 30 ° for ulnar deviation. The Wrist Score of May was excellent at 64%, Good at 16%, Satisfactory at 20% and we have not had bad results. Our preoperative Dash Score was 86 points and in the Post-operative of 13 points. The average of the contralateral comparative force was 70%. CONCLUSION: The arthroscopic repair of the Palmer 1B / Atzei 1 lesions gives satisfactory results improving the ROM, recovering the strength totally or partially and decreasing the pain. We found that the time between surgery and the results obtained influences the results and the greater the follow-up the better the results. Type study: Number of cases. Level of evidence: IV.

Analysis of Results of Arthroscopic Repair of Triangular Fibrocartilage Complex (TFCC) Injury.

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.

Progress in diagnosis and treatment of traumatic injury to triangular fibrocartilage complex / 中华创伤骨科杂志

Triangular fibrocartilage complex (TFCC) plays an important role in maintaining stability of the distal radioulnar joint (DRUJ),buffering the ulnar carpal axial impaction and holding the proximal carpal bones.Patients with injured TFCC may suffer pain over the ulnar side of the wrist and DRUJ instability.Many of them may have difficulty in undertaking daily activities,leading to even psychological problems.With the development of arthroscopic technology and updated understanding of the mechanisms of TFCC injury,great progress has been made in the diagnosis and treatment of the traumatic injury,especially in the arthroscopy-assisted treatment.

Traumatic Triangular Fibrocartilage Complex Injuries and Instability of the Distal Radioulnar Joint / 대한정형외과학회잡지

Traumatic triangular fibrocartilage complex (TFCC) injuries require multidisciplinary approach and plan. Trauma to TFCC can lead to instability of the distal radioulnar joint (DRUJ). Injury to TFCC is classified as a stable type that does not cause unstable lesions for DRUJ or unstable type that can cause instability of DRUJ. According to the location and severity of the injury, arthroscopic debridement or arthroscopic repair may be considered. In the ulnar side avulsion of TFCC, which could cause DRUJ instability, arthroscopic examination should be performed to identify an accurate location of the damaged structures, followed by arthroscopic debridement and repair. In the event of TFCC and DRUJ injuries with ulnar positive variance, arthroscopic TFCC repair or ulnar shortening osteotomy after arthroscopic debridement could be considered to solve the instability and ulnar side pain. However, if peripheral TFCC tear with ulnar impaction syndrome and DRUJ instability, it combined operation of ulnar shortening osteotomy and TFCC foveal fixation could be considered. An accurate classification of TFCC and DRUJ injuries is necessary. It is important to resolve and prevent recurrence of ulnar wrist pain caused by instability.

Diagnosis and Management of Ligament Injuries of the Wrist

The wrist joint is formed by the distal end of the radius and ulna proximally, and eight carpal bones distally. It has many ligaments to maintain stability of the complex bony structures. The incidence of ligament injuries of the wrist has increased due to sports activities. However, diagnosis and management of these injuries are sometimes difficult because of the anatomic complexity and variable injury patterns. Among them, scapholunate ligament injury and triangular fibrocartilage tears are the two most common injuries resulting in chronic disabling wrist pain. Thorough understanding of the wrist anatomy and physical and radiologic examination is mandatory for proper diagnosis and management of these conditions. This article will briefly discuss the wrist joint anatomy and biomechanics, and review the diagnosis and management of the scapholunate ligament injury and triangular fibrocartilage injury.

Scaphoid fracture treated by percutaneous fixation with arthroscope assistance / 中国内镜杂志

Objective To investigate the preliminary clinical results of treating scaphoid fracture by percutaneous fixation with arthroscope assistance. Methods From October 2009 to May 2015, a consecutive series of 12 patients with scaphoid fracture were treated by percutaneous fixation with arthroscope assistance. Meanwhile TFCC was man-aged if necessary. As followed, X-ray was adopted for assessment bone healing at 6-month postoperation, 12-month postoperation. Postoperative evaluations included clinical measurement (grip strength and motion range), radiograph-ic, and functional (modified Mayo wrist score) parameters, Herbert and Fisher scaphoid fracture parameters. Healthy wrist as control group. Results All the scaphoid fracture were healed with an average healing time of 24 weeks. All 12 cases were followed for an average of 18.5 months. The function was rated excellent in 7 cases, good in 5 cases according to the modified Mayo wrist score. There was no difference between the injuried wrist and control group. Conclusion For scaphoid fracture, percutaneous fixation with arthroscope assistance is a reliable and minimally in-vasive method to treat scaphoid fracture.

Luxación radio-cubital distal expuesta por mordedura canina no asociada con fractura: Técnica quirúrgica reconstructiva mediante anclaje para sindesmosis e injerto tendinoso. Reporte de caso / Exposed distal radio-ulnar dislocation by dog bite: Reconstructive surgical technique using a soft tissue graft and a syndesmotic fixation implant. Case report

La función principal del antebrazo es la pronosupinación, la cual se logra en gran medida mediante la estabilidad y características biomecánicas de la articulación radio-cubital distal. Existen diversas técnicas quirúrgicas para el tratamiento de las luxaciones radio-cubitales distales aisladas o asociadas con fractura. Presentamos el caso de un paciente entrenador canino quien fue mordido a nivel de la muñeca y antebrazo distal acudiendo al Servicio de Urgencias en donde se diagnostica una luxación cubital distal con exposición músculo tendinosa. Debido al agente lesivo y las múltiples lesiones de partes blandas resultó imposible realizar las técnicas habituales de tratamiento. Se describe la técnica utilizada para el manejo de este paciente mediante la colocación de injerto tendinoso autólogo de gracilis, plasma rico en plaquetas y dos sistemas de anclaje para sindesmosis de tobillo. Se inmovilizó por seis semanas e inició rehabilitación subsecuente y valorándolo a las 12, 18 y 28 semanas mediante la escala de MAYO, DASH y PRWE encontrando un resultado bueno que implica la reincorporación a las actividades laborales y cotidianas del paciente con un mínimo dolor y limitación.

The main function of the forearm is the supination, which is achieved largely through the biomechanical characteristics and stability of the distal radio-ulnar joint. There are several surgical techniques for the treatment of distal radio-ulnar dislocations isolated or associated with a fracture. We report the case of a canine trainer who was bitten at the wrist and distal forearm that came to the emergency department in where distal ulnar dislocation with muscle tendon exposure was diagnosed. Due to the offending agent and multiple soft tissue injuries the treatment with standard techniques was impossible. We describe the technique of treatment of this patient by placing autologous gracilis tendon graft, platelet rich plasma and two anchoring systems for ankle syndesmosis. Immobilization was maintained for six weeks with a subsequent rehabilitation and posterior valuation at 12, 18 and 28 weeks by the scale of MAYO, PRWE and DASH and finding a good result which implies the return to work and daily activities of the patient with minimal pain and limitation.

Magnetic resonance imaging of the triangular fibrocartilage complex / 实用放射学杂志

Objective To investigate the value of MR 3D fs SPGR(three-dimensional fat-suppressed spoiled gradient echo se-quence)in displaying the general structure of normal triangular fibrocartilage complex(triangular fibrocartilage disc,palm dorsal dis-tal radioulnar ligament,ulnolunate ligament,ulnotriquetral ligament,ulnar collateral ligament,extensor carpi sheath and articular disc homologues).Methods 1 5 normal adults(30 carpals)were examined withconventional sequences including axial fast spin-echo T1-weighted images (FSE T1 WI)or T2-weighted images (T2 WI),coronal fat-suppressed fast spin-echo T2-weighted images (FSE fsT2 WI)and coronal 3D fs SPGR.As well,3D image reconstruction was performed.Two experienced radiologists read the images with an agreement and recorded the display rate of general structure of TFCC.Results Triangular fibrocartilage disc,articular disc homologuespalm,dorsal distal radioulnar ligament,and extensor carpi sheath were totally showed on coronal and cross sections.Ulnolunate liga-ment and ulnotriquetral ligament were totally seen on the coronal plane,and the display rates on cross-section were 93.3%(28/30), 96.7%(29/30)respectively.Ulnar collateral ligament was seen on cross-section and coronal plane 83.3%(25/30),86.7%(26/30)re-spectively.Conclusion Coronal 3D fs SPGR sequence can be used as a regular sequence for observing TFCC and the surrounding lig-aments .

MRI and MRA in Detecting Wrist Triangular Fibrocartilage Tear：A Meta-analysis / 中国医学影像学杂志

Purpose Accurate diagnosis of triangular fibrocartilage (TFC) tear is very important for treatment. MRI is most used for diagnosing TFC tear. This paper aims to evaluate MRI and MR arthrography (MRA) for diagnosing TFC tear by meta-analysis. Materials and Methods The articles were searched in the databases such as Wanfang, VIP, CNKI, Cochrane Library, Medline, Embase and PubMed. The QUADAS items were used to evaluate the quality of the included studies. Heterogeneity of the included articles was tested. The pooled weighted sensitivity and specificity of MRI and MRA in diagnosing TFC tear were calculated, and the pooled receiver operation curve was drawn. Results Fifteen articles met the inclusion criteria, 2 were Chinese articles and 13 were English articles. The subjects and methods of the articles were different and existed heterogeneity. The sensitivity and specificity of MRI for diagnosing TFC tear were 0.66 (95% CI 0.61-0.71) and 0.75 (95% CI 0.69-0.81), and those of MRA were 0.80 (95% CI 0.73-0.87) and 0.86 (95% CI 0.74-0.93). The area under curve and Q* index of SROC of MRI were 0.8566 and 0.7875, respectively. The area under curve and Q* index of SROC of MRA were 0.9123 and 0.8446, respectively. Conclusion The accuracy of TFC tear avulsion for MRA are higher than for MRI, when there is unclear of TFC avulsion using MRI, MRA can be used for diagnosis.

Reparación artroscópica con anclas sin nudo para las lesiones 1B y 1C del complejo fibrocartílago triangular / Arthroscopic repair with knotless anchors for 1B and 1C complex triangular fibrocartilage lesions

Las lesiones del complejo fibrocartílago triangular (CFCT) comienzan a ser más frecuentes en la consulta diaria, con el advenimiento de la artroscopia de muñeca son múltiples las técnicas que se están realizando para la reparación de las lesiones tipo 1B y 1C de Palmer, en este trabajo presentamos nuestra experiencia en el uso de anclas sin nudos con paso de sutura vertical para la reparación del CFCT(AU)

The triangular fibrocartilage complex (TFCC) injuries are becoming more common in daily practice, with the advent of wrist arthroscopy are many techniques that are being made to repair Palmer´s lesions type 1B and 1C, in this paper we present our experience using knotless anchors with vertical suture passage to TFCC repai(AU)

Clinical Outcomes of Open Surgical Repair for Triangular Fibrocartilage Complex Foveal Detachment

PURPOSE: To investigate short term clinical outcomes of the open surgical repair for triangular fibrocartilage complex (TFCC) foveal detachment. METHODS: We retrospectively reviewed 8 patients (5 men, 3 women) who had been treated with open surgical repair of the TFCC type 1B injury, from 2005 to 2013 and who were followed up for more than one year after surgery. Mean age at time of surgery was 34 years. The right side was involved in 3 patients, and the left in 5. The clinical results of surgery were assessed with modified Mayo wrist score (MMWS), disabilities of the arm, shoulder and hand (DASH) score and pain-visual analogue scale (VAS). Physical examination was performed to evaluate the prescence of distal radioulnar instability, preoperatively and at the latest follow-up. RESULTS: The mean follow up period were 36.5 months (range, 12-64 months). The mean MMWS improved from 52.5 (range, 25-85) preoperatively to 82.5 (range, 75-100) postoperatively (p=0.02). The mean DASH score improved from 39.6 (range, 65-13.5) preoperatively to 13.4 (range, 2.5-33.3) postoperatively (p=0.012). The preoperative mean pain-VAS was 4.6 (range, 6-3); these value was reduced to mean 2 (range, 0-3) at the latest follow-up (p=0.016). There were no patients remaining instability after the surgery, although four patients showed distal radioulnar joint (DRUJ) instability before surgery. CONCLUSION: The surgical outcomes of open repair for TFCC foveal detachment (type 1B) was contentable. Also, in cases of type 1B injury associated with DRUJ instability were managed sucessfully without additional procedure.