Background and purpose To introduce using non-surgical treatment with a wrist brace even after conservative treatment failed as an alternative to surgical treatment in areas with limited modalities. Material and methods This study is a case report of a 24-year-old male who fell from a motorbike on his left hand and had difficulty supinating, extending, and flexing his left wrist. The ulnar fovea sign and piano key sign were positive. No fracture was found, only soft tissue swelling on the wrist X-ray. The MRI couldn’t be performed due to the patient’s financial and distance limitations related to the MRI facility. After 6 weeks, the conservative management failed to improve the pain in his left wrist. The patient refused surgery and chose to wear a wrist brace (Wrist Widget®). Result After using a wrist brace for 6 months, the patient’s weight-bearing capacity returned to 100%, and his DASH score improved from 70 to 0. The piano key sign was negative; the patient’s wrist ROM returned to 100%, and he can do daily activities without any pain. Finally, the MRI was done at the end of the 6th month since the patient had sufficient funds. This case’s injury type is a partial type 1B tear which is an ulnar avulsion without an ulnar fracture and with DRUJ instability. This type is often associated with DRUJ instability and needs cautious evaluation. This type has good blood supply because the injury location is located more in the periphery, which is the most compliant to repair and has a good healing feature. On the MRI, there is hyperintensity, which suggests a sign of healing of the TFCC. Conclusion During 6 months of regular usage of this brace, the patient's injured wrist fully recovered. It is still possible to use non-surgical treatment even after conservative treatment has failed.

Artificial intelligence (AI) is becoming increasingly integrated into clinical care in hand surgery. Its applications extend across diagnosis, planning, intraoperative assistance, postoperative monitoring, rehabilitation, prosthetics and education. In diagnostic imaging, AI improves the detection of distal radius and scaphoid fractures, estimates osteoporosis from hand radiographs, identifies triangular fibrocartilage complex injuries on magnetic resonance imaging, segments bones and cartilage, and supports dynamic wrist analysis; ultrasound- and neurophysiological-based models aid carpal tunnel syndrome diagnosis. Prognostic models predict outcomes after carpal tunnel release and thumb carpometacarpal osteoarthritis with mixed performance. Pre- and intraoperative applications include large language model-based triage and coding, navigation and phase/gesture recognition from surgical video, autonomous microsurgical prototypes and telemanipulator platforms for supermicrosurgery. Artificial intelligence-enabled telemonitoring (e.g. remote photoplethysmography) and video-based mobility tracking support postoperative care and rehabilitation. Vision-guided and multimodal sensing enhance myoelectric prosthesis control. Risks include data privacy and security, algorithmic bias (data, transposition, normative, annotation) and opacity, overreliance with automation bias and skill erosion, and unresolved legal and ethical questions (liability, conflicts of interest, compassion in care). Balanced adoption requires diversified datasets, privacy-preserving strategies (pseudonymization, differential privacy, federated learning), transparent reporting, AI literacy and ethics in medical education and interfaces that expose uncertainty and employ cognitive forcing functions. Post-deployment surveillance should track data drift, out-of-distribution inputs and performance using automated alerts and multidisciplinary review. Artificial intelligence should augment, never replace, clinical judgment, with explicit role delineation and continuous monitoring to safeguard equity and patient-centred outcomes.

Wrist arthroscopy has become an essential tool for treating intraarticular pathologies, with advancements in techniques and instruments expanding its indications over the past few decades. It is the benchmark for diagnosing intraarticular ligament pathologies, such as scapholunate ligament and triangular fibrocartilage complex injuries. In addition, it can be used an adjunct in the management of intraarticular fractures, particularly distal radius and scaphoid fractures. The objective of this article is to outline the role of arthroscopy in the management of common radial-sided wrist disorders and evaluate the surgical outcomes.

The distal radioulnar ligaments (DRULs) serve as primary stabilizers to the distal radioulnar joint (DRUJ). Existing cadaveric studies report heterogeneous morphometric data of the three-dimensional (3D) anatomy of the triangular fibrocartilage complex (TFCC) and the ulnar footprints of the DRULs due to methodological variations and small sample sizes, limiting the translation of precise anatomical knowledge to clinical practice. This study quantitatively evaluated the 3D anatomy of the TFCC and the insertions of both superficial and deep DRULs components using three different methods with subsequent interactive validation: (1) direct measurement, (2) 3D scan, and (3) artificial intelligence (AI) enhanced magnetic resonance imaging. Eleven adult cadaveric upper limbs were included. All specimens underwent 3.0-Tesla MRI scans, which were then processed by AI algorithms for super-resolution enhancement and semi-automatic segmentation. The areas of deep and superficial limbs of DRUL ulnar footprint were measured in the super-resolution MRI images using the Slicer software. The specimens were then dissected and anatomical measurements of dorsal-volar maximal length and radial-ulnar maximum length of deep ulnar DRUL footprint were performed on the specimens' photographs. Anatomical measurements of ulna, radius, triangular fibrocartilage, and ulnar insertions footprint of both superficial and deep DRULs were conducted subsequently using a 3D scanner. Primary outcome measures included the area and morphological classification (irregular quadrilateral, ribbon, semilunar) of the deep and superficial ulnar DRUL footprints. Statistical analysis encompassed intraclass correlation coefficients (ICC) for agreement assessment and multiple linear regression to explore associations. The mean area of the deep foveal fibers of DRUL was 43.39 ± 13.49 mm2 and the superficial footprint was 20.11 ± 10.49 mm2 as measured with the 3D scanner. The morphologic features of the deep footprint shapes varied, with the most common shape being a ribbon (7/11, 64%). The intraclass correlation coefficients (ICCs) for the measurement of dorsal-volar maximal length and radial-ulnar maximum length of the DRUL between direct measurement and the 3D scan were excellent (ICC = 0.97 and 0.98, respectively). The ICCs between the AI-enhanced analysis and the 3D scan for measuring the ulnar deep and superficial DRUL insertion areas were excellent (ICC = 0.95 and 0.96, respectively). Multiple linear regression explained 72.4% of the variance in deep DRUL footprint area (R2 = 0.724, p = 0.147), with the superficial footprint area showing the strongest association (β = 0.639, p = 0.196). Compared to direct measurement and 3D scan, the AI algorithms developed and validated for wrist MRI image enhancement demonstrated high accuracy and reliability in anatomical measurements of DRULs.

This study aimed (1) to provide a stepwise, reproducible description of a single-bone-tunnel, two-stranded, anchorless ligament-specific ('en Masse') repair for traumatic peripheral TFCC tears, and (2) to evaluate one-year clinical outcomes and exploratory prognostic factors in a retrospective consecutive case series. Forty-eight patients were retrospectively included. Postoperatively, ballottement testing revealed no detectable distal radioulnar joint (DRUJ) laxity (p < 0.001). The mean visual analog scale (VAS) pain score (7.2 to 1.9), grip strength (66.1% to 81.3%), Mayo wrist score (MWS, 64.3 to 81.9), and Disabilities of the Arm, Shoulder, and Hand (DASH) score (37.1 to 12.7) were improved postoperatively (p < 0.001). There were no surgery-related complications. On multivariable analysis, longer symptom duration (p = 0.031) and positive ulnar variance (p = 0.045) were associated with lower MWS; model fit was modest (R2=0.224). Arthroscopic-assisted en Masse repair for peripheral TFCC tears was associated with improved clinical outcomes at one year or more after surgery, and postoperative ballottement testing revealed no detectable DRUJ laxity. Within this cohort, one-year follow-up precluded assessment of long-term durability; also, applicability to degenerative/chronic peripheral TFCC tears remains undetermined.

The purpose of this study is to develop an automated model to assist in the detection of substructural injuries of the triangular fibrocartilage complex (TFCC), thereby reducing the reliance on subjective assessment. This retrospective study utilized 330 TFCC injured patients and 273 healthy controls from two institutions, only analyzing 2821 coronal fat-saturated T2-weighted imaging slices. From 483 samples (267 injured, 216 normal), 2292 images were processed: 1834 for training, 458 for validation, with an internal test set of 209 images from 47 samples (26 injured, 21 normal). An external test set comprised 320 images from 73 samples (37 injured, 36 normal) at another institution. Radiologists segmented and classified TFCC substructures by consensus. Different YOLO versions were trained and compared, with the optimal model benchmarked against musculoskeletal (MSK) radiologists (Resident1 and Attending2). Among evaluated YOLO versions, the YOLO11l model exhibited the optimal segmentation performance, with mean Dice (mDice) coefficients of 0.82 (internal test set) and 0.77 (external test set). Its classification sensitivity, specificity, and accuracy were 91.67%, 76.11%, and 83.25% on the internal test set, significantly outperforming other versions. On the external test set, corresponding values were 84.68%, 61.22%, and 71.00%, representing the best overall performance. Notably, the diagnostic performance of the YOLO11l model was non-inferior to that of Resident1 (p = 0.41) but inferior to that of Attending2 (p = 0.015). The YOLO11l model represents a promising approach to aiding the assessment of TFCC injuries. Compared with less experienced radiology residents, this model can provide reliable and reproducible diagnostic support.

Purpose: This study aimed to compare the radiographic and clinical outcomes of ulnar shortening osteotomy (USO) alone versus USO combined with arthroscopic transosseous foveal repair of the triangular fibrocartilage complex (TFCC) in patients with ulnar impaction syndrome (UIS) and TFCC foveal tears.Methods: Eighteen patients with UIS and TFCC foveal tears who presented with lunate chondral lesions on preoperative radiographs were retrospectively reviewed. Group 1 (n=9) underwent USO alone, and group 2 (n=9) received USO with arthroscopic TFCC repair. Lunate chondral lesion size and ulnar variance were evaluated preoperatively and at 6 weeks, 6 months, 1 year, and 2 years postoperatively. Clinical outcomes, including the visual analog scale, Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, Mayo Wrist Score, and Patient-Rated Wrist Evaluation, were assessed serially.Results: Both groups demonstrated progressive postoperative healing of lunate chondral lesions. However, group 2 exhibited significantly faster reduction in lesion size. Ulnar variance decreased in both groups postoperatively but remained stable in group 2. Group 1 showed a progressive increase in ulnar variance, with significant differences between groups at 6 months and 2 years (p&lt;0.05). Clinical scores improved in both groups, but no significant intergroup differences were observed.Conclusion: USO combined with arthroscopic TFCC foveal repair resulted in superior radiographic outcomes compared to USO alone, demonstrating more consistent healing of lunate chondral lesions and sustained correction of ulnar variance over 2 years. Although these radiographic improvements did not correspond to significantly better clinical scores, restoring distal radioulnar joint stability through TFCC repair may contribute to improved long-term durability and functional outcomes after USO.

Purpose: Triangular fibrocartilage complex (TFCC) injuries are clinically significant. However, standardized diagnostic coding and treatment guidelines remain lacking, particularly regarding the optimal duration of conservative management before surgery. This study investigated current practices among Korean hand surgeons concerning diagnostic coding and conservative treatment for traumatic TFCC tears.Methods: An online survey was distributed to 88 selected members of the Korean Society for Surgery of the Hand. The questionnaire addressed the selection of diagnostic codes for acute and chronic traumatic TFCC tears, and the recommended duration of conservative treatment. Multiple responses were permitted. Subgroup analyses considered clinical experience, hospital type, subspecialty certification, and board membership.Results: Sixty-two hand surgeons responded (70.4% response rate). For acute TFCC tears, 76.8% selected code S63.3 (traumatic rupture of ligament of wrist and carpus), and 53.8% recommended 3 months of conservative treatment. Coding was more variable for chronic TFCC tears, with increased use of M24.23 and unspecified codes. Subspecialists more consistently selected S63.3 for acute tears (p=0.040), but no significant subgroup differences were observed regarding treatment duration or chronic tear coding.Conclusion: Most Korean hand surgeons favored S63.3 for acute TFCC injuries and recommended a 3-month conservative treatment period. However, the variability in chronic coding and treatment practices suggests that TFCC-specific codes are necessary, as well as unified clinical guidelines to support standardized care and administrative accuracy.

The recently introduced CUP classification of the triangular fibrocartilage complex divides the lesions into central (C), ulnar (U), and peripheral (P). The periphery of the triangular fibrocartilage complex consists of the meniscus homologue, the ulnocarpal joint capsule including the extensor carpi ulnaris tendon sheath, and the ulnotriquetral and ulnolunate ligaments. Peripheral triangular fibrocartilage complex lesions can occur in isolation or in combination with injuries of the ulnar insertions and/or the articular disk. Most commonly the meniscus homologue and dorsal capsule are affected. Magnetic resonance imaging and computed tomography/magnetic arthrography are used to assess peripheral lesions. The arthroscopic assessment of peripheral triangular fibrocartilage complex lesions is limited. To date, data on the clinical relevance of the radiologic reporting of peripheral lesions are lacking. This pictorial review illustrates typical peripheral lesions of the triangular fibrocartilage complex according to the CUP classification.

The distal radioulnar joint is essential for forearm rotation and wrist stability. Instability of the distal radioulnar joint, often resulting from trauma, ligamentous injury, or degeneration, can lead to pain, functional impairment, and progressive joint damage. Accurate diagnosis relies on a thorough imaging assessment due to the complex joint anatomy, especially the triangular fibrocartilage complex.Standard radiographs are useful to evaluate bone alignment but have limited soft tissue sensitivity. Ultrasound provides dynamic real-time assessment of superficial structures, although it is operator dependent. Computed tomography offers excellent spatial resolution for bony abnormalities and joint congruity, with a static and pseudo-dynamic approach, considered the gold standard.Magnetic resonance imaging is the reference standard for soft tissue evaluation, particularly the triangular fibrocartilage complex and surrounding ligaments. Emerging dynamic imaging techniques, including real-time magnetic resonance imaging and four-dimensional computed tomography, allow visualization of joint kinematics and detection of subtle instabilities not seen on static images. This review outlines the role of each modality in assessing distal radioulnar joint instability.

This case-based review explores the biomechanical foundations of the wrist by integrating advanced imaging findings with core anatomical and functional principles. We analyze six representative scenarios: distal radioulnar joint instability, ulnocarpal impaction, unstable triangular fibrocartilage complex tear, scapholunate ligament injury, posttraumatic ulnar translocation of the carpus, and scaphotrapeziotrapezoid osteoarthritis. The cases reviewed here illustrate how static and dynamic stabilizers preserve carpal congruence and load transmission. We highlight the roles of the triangular fibrocartilage complex, the distal interosseous membrane, and the intrinsic and extrinsic ligament systems, along with the kinematic interplay between carpal rows and sensorimotor control mechanisms. We emphasize the value of magnetic resonance imaging, magnetic resonance arthrography, and wrist arthroscopy as essential tools for detecting instability and planning treatment. By applying biomechanical principles to imaging interpretation, we can enhance lesion pattern recognition, support informed surgical decision making, and foster a more effective multidisciplinary approach to wrist pathology.

Optimized step-cut ulnar shortening osteotomy: A less invasive technique with a dedicated guide and plate.

Assessment Strategies for Distal Radioulnar Joint Instability: Current State and a Need for Improved Tools.

Frequency and Outcomes of Distal Radioulnar Joint Dislocation Associated With Distal Radius Fractures in the Elderly

To investigate the effectiveness of three-dimentional (3D) printed personalized guide plate-assisted wrist arthroscopic repair for Palmer type ⅠB triangular fibrocartilage complex (TFCC) injury. A retrospective analysis was conducted on the clinical data of 20 patients with Palmer type ⅠB TFCC injuries admitted between January 2023 and March 2024 who met the selection criteria. Among them, 13 were male and 7 were female; ages ranged from 23 to 35 years, with a mean age of 30.3 years. All patients had a history of trauma, 12 cases involved falls and 8 cases involved sprains. All patients demonstrated a positive "piano key sign". MRI revealed deep ulnar-side tears of the TFCC. Conservative treatment for 6 weeks yielded poor or no clinical improvement. The interval from injury to surgery ranged from 2 to 9 months, with a mean of 5.0 months. Patients underwent wrist arthroscopic repair assisted by 3D printed personalized guide plate. Functional recovery was assessed preoperatively and postoperatively using the visual analogue scale (VAS) score for pain, modified Mayo wrist score, and range of motion (ROM) measurements for wrist flexion-extension, ulnar-radial deviation, and pronation-supination. At last follow-up, MRI was performed to evaluate the healing of TFCC. All 20 patients underwent successful surgery without complications such as vascular or nerve injury, fracture, incisional infection, or joint stiffness. All patients were followed up 9-18 months (mean, 12.4 months). At last follow-up, patients demonstrated significant improvements in VAS scores, modified Mayo wrist scores, wrist flexion-extension ROM, ulnar-radial deviation ROM, and pronation-supination ROM compared to preoperative levels ( P<0.05). MRI at last follow-up showed preserved TFCC continuity, excellent healing, and secure fixation. 3D-printed personalized guide plate significantly improve outcomes in wrist arthroscopic TFCC repair for Palmer type ⅠB injuries. They enable high-quality suturing, facilitate anatomical reconstruction, and markedly enhance wrist function.

Abstract Traumatic or degenerative changes in the triangular fibrocartilage complex (TFCC) commonly cause ulnar-sided wrist pain and dysfunction. Arthroscopic techniques for the treatment of these injuries have gained popularity due to their minimally invasive nature and improved visualization. This article presents a novel arthroscopic technique for TFCC repair named Around Styloid. This is a modification of an open technique described by Argintar and Mantovani in 2010. This technique seeks to simplify the technique of foveal reinsertion of the TFCC, using basic elements and sutures in surgery. Traditional open techniques for TFCC repair can be technically demanding and may involve bony tunneling in the foveal joint region of the distal ulna. Arthroscopic techniques have emerged as a less invasive alternative, but they can still present challenges, particularly for surgeons with limited experience. The arthroscopic “Around Styloid” novel technique appears as an alternative that seeks, in a simple way, to perform foveal reinsertion of the TFCC, avoiding the need to perform the bone tunnels directed to the fovea of the ulna, which may represent a great surgical challenge, especially for surgeons in the process of learning arthroscopic techniques.

Direct traction device for wrist magnetic resonance (MR) imaging.

Combined Transosseous and Capsular Repair Improves Grip Strength in Triangular Fibrocartilage Complex Tears: A Randomized Controlled Trial.

Ulnar-sided wrist pain, frequently linked to triangular fibrocartilage complex (TFCC) injuries, poses a diagnostic challenge due to the limited sensitivity and specificity of standard clinical tests. Although wrist arthroscopy remains the diagnostic gold standard, a reliable clinical tool is needed to better identify peripheral TFCC lesions (Palmer 1B). This study introduces and validates the "TFCC Table Lift Test" (TTL test), a novel exam aimed at improving clinical detection of Palmer 1B TFCC injuries. The primary goal was to correlate TTL test scores with arthroscopic findings, using the Atzei classification to subcategorize lesions and assess the test's diagnostic utility. We conducted a retrospective case-control study involving 314 patients with unilateral chronic ulnar-sided wrist pain who underwent wrist arthroscopy from January 2016 to December 2023. All patients performed the TTL test during preoperative assessment, which involved lifting a flat surface with fingertips while the wrist was in full supination and extension. Pain intensity was scored using a Visual Analogue Scale (VAS, 0-10) and compared to the unaffected side. Exclusion criteria included bilateral pain, previous wrist surgery, or other wrist disorders. Arthroscopy confirmed or excluded Palmer 1B TFCC lesions and subclassified them using the Atzei system. TTL scores were statistically analyzed for diagnostic correlation. Of 314 patients, 213 (Group 1) were arthroscopically diagnosed with Palmer 1B TFCC lesions: 136 were Atzei Class 1, 75 Class 2, and 2 Class 3. The remaining 101 patients (Group 2) had other wrist conditions. All Group 1 patients had TTL scores >5, with severity reflected in increasing mean scores (Class 1: 6.52; Class 2: 8.15; Class 3: 9.0). All but three patients in Group 2 had scores <3. The TTL test showed 100% sensitivity, 97.03% specificity, 98.6% positive predictive value, and 100% negative predictive value. ROC analysis yielded an AUC of 0.999; the optimal threshold was VAS >5. The TTL test is a simple, reproducible, and accurate clinical tool for detecting Palmer 1B TFCC lesions. A TTL score >5 strongly correlates with arthroscopic findings and reflects lesion severity, making it a valuable adjunct in the evaluation of ulnar-sided wrist pain.

Background: The distal oblique bundle (DOB) of the interosseous membrane (IOM) has been recognized as an important stabilizer of the distal radioulnar joint (DRUJ). However, its prevalence, morphology, and distal attachments—particularly its relationship to the articular disc and the extensor carpi ulnaris (ECU) tendon sheath—remain inconsistently described. Clarifying these anatomical details is essential for understanding DRUJ stability and guiding surgical reconstruction. Methods: The distal IOM was examined in 48 specimens from 24 embalmed Korean cadavers. In 46 dissected specimens, the presence, morphology, and attachment sites of distal interosseous structures were documented, and attachment levels were measured. In 38 specimens, attachment to the articular disc was assessed. In addition, serial transverse sections from one cadaver were analyzed to confirm three-dimensional relationships. Results: Two morphological patterns were identified: a distinct DOB (21/46, 45.7%) and, when absent, a membranous thickening of the distal IOM (25/46, 54.3%). The mean attachment level was 39.1 ± 9.7 mm for the DOB and 25.4 ± 4.8 mm for the membranous thickening. Both structures assumed an oblique orientation, fanning palmarly toward the capsule and articular disc and dorsally toward the ECU tendon sheath and dorsal septum. In 26 of 38 specimens (68.4%), these structures attached to the proximal palmar portion of the articular disc. Serial transverse sections confirmed this oblique configuration, linking palmar and dorsal stabilizers of the DRUJ. Conclusions: The distal IOM consistently forms specialized structures—either a DOB or a membranous thickening—that integrate with the triangular fibrocartilage complex. By bridging palmar and dorsal stabilizers, these structures contribute to joint congruency and load transfer during forearm rotation. A refined anatomical understanding of these patterns provides clinically relevant insights for surgical preservation or reconstruction, with the potential to improve outcomes in patients with chronic DRUJ instability.