Diagnosis and treatment of Palmer type IB TFCC injury using wrist arthroscopy

Abstract

Objective To evaluate the value of wrist arthroscopy in the diagnosis and treatment of Palmer type ⅠB TFCC injuries. Methods Thirty-two cases of TFCC injury (Palmer type ⅠB) that were diagnosed and treated with wrist arthroscopy between January 2013 and February 2015 were analyzed retrospectively. According to Palmer classification, 10 cases had accompanying ulnar styloid fracture, 5 cases had accompanying type ⅡA injury, 8 cases had accompanying type ⅡB injury, and 6 cases had accompanying type ⅡC injury. For cases without accompanying type Ⅱ injury, endoscopic repair of ulnar joint capsule (outside-in or in-outside suturing) was performed. Chondroplasty was carried out in cases with accompanying type ⅡB injury, while arthroscopic debridement, chondroplasty and ulnar head Wafer excision were done in cases with accompanying type ⅡC injury. Preoperative and postoperative assessments included visual analog pain scores (VAS), grip strength, range of motion, and modified Mayo wrist score. Results All the patients were follow-up with a mean time of 13.4 months. There were no complications. Significant wrist pain relief was achieved, with VAS score reducing from (6.0±2.3) points preoperatively to (1.0±1.1) points one year postoperatively. Grip strength increased from preoperative (60.3±4.3)% of the contralateral side to (82.0±4.1)% one year postoperatively. Wrist range of motion changed from (62.0±4.3)° to (105.0±4.3)° for flexion/extension and from (125.0±16.0)° to (152.0±18.0)° for pronation/supination. The outcomes were rated as excellent in 26 cases, good in 3 cases, and fair in 3 cases by modified Mayo wrist score, with an excellent rate of 90.6%. Conclusion Wrist arthroscopic diagnosis and treatment of Palmer type ⅠB TFCC injury is safe and effective. Key words: Wrist; Arthroscopes; Triangular fibrocartilage complex