Triangular Fibrocartilaginous Complex Research Articles

Robot-assisted transosseous repair of triangular fibrocartilage complex: a cadaver study.

The feasibility and accuracy of robot-assisted bone tunnel construction in the transosseous repair of the triangular fibrocartilaginous complex (TFCC) were compared with those of freehand arthroscopic repair. A total of 20 cadaveric specimens were randomized into robotic-assisted and arthroscopy-guided groups. Three bone tunnels were constructed in the ulnar foveal region in each specimen. The discrepancy between the planned and actual tunnel exits was determined in the robot-assisted group by merging images. The success rate of tunnel construction, time consumption and number of drilling attempts were compared between groups. The median planned/actual exit discrepancy was 0.8 mm in the robot-assisted group, with 90% of tunnel exits successfully placed in the footprint region, compared to 63.3% in the arthroscopy-guided group. The robot-assisted group spent less time and required fewer drilling attempts to construct bone tunnels. These results indicated that the robot-assisted technique can accurately construct multiple bone tunnels in the foveal region and reduce the difficulty of TFCC transosseous repair.Level of evidence: III.

NanoScope wrist arthroscopy under wide-awake local anesthesia with no tourniquet: A prospective series of 30 consecutive patients

IntroductionWrist arthroscopy is an evolving procedure. The purpose of this study was to report the outcome of diagnostic arthroscopy of the wrist using a new tool, the NanoScope, under wide-awake local anesthesia with no tourniquet (WALANT). Patients and methodsThis was a prospective study of 30 consecutive patients with suspected ligament tear after wrist trauma and remaining symptoms after initial conservative management. All patients had an MRI prior to the NanoScope procedure. ResultsThe patients comprised 17 men and 13 women, with a mean age of 31 years. One patient declined the NanoScope procedure following their MRI. In the remaining 29 patients, NanoScope wrist arthroscopy revealed 19 cases of triangular fibrocartilaginous complex (TFCC) tears and 11 tears of the scapholunate (SL) or lunotriquetral (LT) ligaments. The correlation between preoperative MRI and the findings from NanoScope arthroscopy was poor. Six patients had additional surgery after the NanoScope arthroscopy, comprising three TFCC sutures, one SL and one LT ligament reconstruction respectively, and one wrist arthrodesis. No complications related to the NanoScope arthroscopies were noted. ConclusionNanoScope arthroscopy of the wrist is safe, is well-suited for surgery in WALANT, and has superior diagnostic capacity compared to MRI. Further studies are warranted to determine the role of the NanoScope in the management of wrist ligament pathologies. Level of evidenceThis is a level 4 study.

Current concepts and new trends in management of isolated triangular fibrocartilage complex injuries.

The triangular fibrocartilaginous complex is made of multiple components, of which the palmar and dorsal radioulnar ligaments play an important role in distal radioulnar joint stability. The ulnar wrist ligaments may be injured during forearm and wrist trauma. There are several aspects of triangular fibrocartilaginous complex management that are still open to debate. The aim of the present study was to review the current concepts and discuss emerging trends to better elucidate and treat this important ligament complex.Level of evidence: V.

Antegrade Fixation of Distal Metaphyseal Ulnar Shortening Osteotomy.

The ulnar shortening osteotomy (USO) is a common procedure used to treat ulnar impaction syndrome secondary to static or dynamic ulnar-positive variance. There are many described techniques for the USO. The distal metaphyseal ulnar shortening osteotomy (DMUSO) with retrograde cannulated screw fixation was described to reduce complications seen with other techniques. Biomechanical analysis of fixation constructs demonstrates 2-screw constructs are significantly stiffer than 1 screw and antegrade constructs have similar or greater stiffness when compared with retrograde constructs. Here, we describe a technique of antegrade cannulated screw fixation for DMUSO that obviates the need for the disruption of the distal radioulnar joint for intra-articular exposure of the ulnar head. Similar to the traditional retrograde DMUSO technique, this construct may also decrease the risk of delayed union, symptomatic implants associated with diaphyseal osteotomies, and disruption of triangular fibrocartilaginous complex in wafer procedures.

Diagnostic Accuracy of Magnetic Resonance Arthrography and its Correlation with Arthroscopy in the Detection of Lesions Triangular Fibrocartilaginous Complex and Intrinsic Ligaments in the Wrist

Objectives: To assess the diagnostic validity and reliability of magnetic resonance arthrography in identifying the lesion of triangular intrinsic wrist ligaments and fibrocartilaginous complex based on arthroscopy as reference standard and preferred modality of imaging. Methodology: This was a retrospective validation study that was carried out at the Radiology department of PESSI (Punjab Employees Social Security) Hospital, Islamabad, between April 2019 and September 2022. A total of 11 patients with an age range 21-58 years, lesions of the triangular fibrocartilaginous complex (TFCC), and MR arthrography were included. MR arthrography images of the wrist were evaluated to assess the integrity of the intrinsic wrist ligaments, including those of the TFCC, scapholunate, and lunotriquetral ligament. MR arthrography injection was performed into the wrist joint, likely to help visualize the ligaments and other structures within the joint. The injection was performed under fluoroscopic guidance, and the size of the needle used for the injection was 20-24G. The data collected from the MR arthrograms and arthroscopy was analyzed using SPSS v 23. Results: The patient’s mean age was 40.0±12.31 years. Out of 11 patients, there were 6 (55.5%) males and 5 (45.5%) females. Sensitivity of MR arthrography is 71.4% and specificity that of 75% for detecting TFCC defects, and a 100% sensitivity and 85.7% specificity for diagnosing intrinsic ligament defects. MR arthrography had an overall accuracy of 73% for detecting TFCC, while the overall accuracy for detecting intrinsic ligament defects was 90.9%. Conclusion: MR arthrography was an adequate diagnostic tool for detecting defects of the intrinsic ligaments and the TFCC of the wrist when compared to diagnostic arthroscopy.

A Stepwise Intraoperative Protocol to Minimize Complications after Volar Plating.

Background Although outcome of volar plating is generally good, care should be taken to avoid specific iatrogenic and preventable complications, with an incidence reporting averaging 15%. Flexor tendon rupture due to a prominent plate, extensor tendon rupture due to a dorsal protruding screw tips, cartilage lesions due to intra-articular screw placement, loss of reduction due to insufficient stability, and persisting ulnar pain with distal radioulnar joint instability due to unstable triangular fibrocartilaginous complex lesions or unstable ulnar styloid base fractures all have been described. Purpose We believe that a majority of these complications can be prevented by meticulous assessment of several intraoperative parameters during volar plating. Therefore, we introduce the WRIST protocol, a stepwise easy-to-remember manual that combines multiple fluoroscopic measurements to guide intraoperative decision making. Conclusion Large prospective studies of the "WRIST" protocol are needed for validation. But we believe that it may help surgeons to optimize surgical technique, functional and radiographic outcome, and prevent complications when treating distal radial fractures.

Arthroscopic Management of the Hamate Proximal Pole Arthrosis.

In this retrospective study, all patients with arthrosis of the proximal pole of the hamate encountered in a 10-year period treated with arthroscopy were reviewed. Patient demographics, arthroscopic details, associated injuries, and procedures were reviewed. Functional and patient-reported clinical outcomes after arthroscopic osteochondroplasty were analyzed. An analysis of 39 patients who underwent arthroscopic osteochondroplasty showed a type II lunate prevalence of 87.2%. On wrist arthroscopy, a triangular fibrocartilaginous complex tear was the most common diagnosis (64.1%), followed by scapholunate ligament tear (61.5%) and lunotriquetral ligament tear (35.9%). All patients were managed arthroscopically with 100% procedural success. Average follow-up of 42.8 ± 37.7 months showed statistically significant improvements in the visual analog score and Mayo wrist score postoperatively (P < 0.01). Three patients (7.7%) failed the procedure at a mean of 23 ± 31.4 months. Risk factors for salvage operations were nondominant wrist involvement 100% (P = 0.04), lunotriquetral ligament injury 100% (P = 0.04), the absence of triangular fibrocartilaginous complex injury 100% (P = 0.04), and the presence of scapholunate advanced collapse 100% (P < 0.01). Wrist arthroscopy is valuable for accurately diagnosing and treating hamate arthrosis and identifying a wide variety of pathologies associated. This study showed arthroscopic osteochondroplasty produced satisfactory clinical results. Furthermore, the presence of scapholunate advanced collapse wrist offers its prognostic value in determining treatment failure.

SHORT TERM FUNCTIONAL OUTCOME OF CLOSED REDUCTION AND FIXATION OF COLLES FRACTURE USING MODIFIED-JOSHIS EXTERNAL STABALIZATION SYSTEM - A PROSPECTIVE STUDY

Colles fracture is the most common fracture seen in adult population. It is never an isolated fracture of the distal radius, but is associated with fracture of ulna styloid which may be displaced or undisplaced instability of the distal radio-ulnar joint complex and may be associated with injury to triangular fibro cartilaginous complex. The aim of study was to determine functional outcome of management of closed reduction and fixation of comminuted colles fracture using a rigid and stable modified-Joshis External Stabalisation System as soon as possible. In our study we have tried to bring associated soft tissue and bony injuries around the wrist joint as a highlighter and focused on fixation and restoration of anatomy to near normal with fixation of all the above mentioned injuries without exposing the joint, and as an immediate and definative management. Out of a total of 30 patients included, 26 patients had an excellent outcome as measured using quick-disability arm shoulder hand score and modified-mayo wrist scoring system. One patient had a superficial pin tract infection and was managed with oral antibiotics. The patients were able to resume the activities of daily living by end of eight weeks. It can be concluded that this method can be employed in immediate and definative management of comminuted colles fractures as it leads to a better functional outcome, lesser hospital stay, early mobilization of the joint, lesser exposure to radiation, avoids joint exposure, has a low learning curve, early resumption of activities of daily living and avoids re-surgery at a later date for implant removal.

AB123. SOH22ABS172. A comparison magnetic resonance imaging (MRI) of and in wrist arthroscopy the diagnosis of Triangular Fibrocartilaginous Complex (TFCC) tears: an Irish perspective

Background: The Triangular Fibrocartilaginous Complex (TFCC) is a load bearing structure that functions as a stabilizer of the ulnar aspect of the wrist and supports the distal radio-ulnar joint (DRUJ). TFCC injuries are common and often occur post trauma. Arthroscopy is the gold standard of diagnosis however many investigate patients with magnetic resonance imaging (MRI) to support a clinical suspicion. Sensitivity for MRI varies widely with recent systematic review reporting MRI sensitivity ranging from 44–93%. TFCC tears associated with distal radius fractures range from 38–78%. Ireland sees approximately 2,475 operatively treated distal radius fractures per year. We can infer that a certain number of these patients have suffered concurrent trauma to their TFCC and as such may present with wrist pain. The aim of this study is to compare MRI and arthroscopy in diagnosing TFCC tears in an Irish patient cohort.

Cervical vertebrae affection in calcium pyrophosphate crystal deposition disease (description of a clinical case)

Calcium pyrophosphate deposition disease (CPPD) is characterized by polymorphism of clinical manifestations: from asymptomatic course to severe chronic arthropathy with destruction of bone structures. It is believed that calcium pyrophosphate crystals are more often found in the knee and so-called root joints (hip and shoulder), as well as in the triangular fibro-cartilaginous complex. However, CPPD can also affect the axial skeleton. A pathological process localized in the spine is more common in older people and is rare at a young age. The article presents a case of chondrocalcinosis of the cervical spine in a 62-year-old female patient who did not have risk factors.

Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging

Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging

Distal interosseous membrane of the forearm: anatomy, biomechanics, diagnostics

Relevance. Recent studies show that even with damage to the structures of the triangular fibrocartilaginous complex (primary stabilizer), instability of the distal ray-elbow joint does not develop in some cases. Studies carried out by a number of authors prove that the distal interosseous membrane of the forearm can influence the stability of the joint and be a secondary stabilizer for it.&#x0D; Aim of the study. To study the variability in the structure of the distal interosseous membrane of the forearm using anatomical material and determine the effect of the distal interosseous membrane on the stability of the distal ray-elbow joint. Using ultrasound to determine the variability of the structure of the distal interosseous membrane of the forearm.&#x0D; Materials and methods. Material for our study was 10 pairs of anatomical specimens of the upper extremities. The functional viability was assessed by passive rotation of the anatomical material of the forearm. Changes in the tension of the distal interosseous membrane, its additional formations and the capsule of the distal ray-elbow joint were observed. Ultrasound was chosen as an instrumental method for visualizing the distal interosseous membrane of the forearm and its structures. In the course of this work, 30 volunteers of both sexes and different ages were examined. The study was carried out: maximum pronation (position of the sensor back) and maximum supination (position of the sensor palmar).&#x0D; Results. In the course of the anatomical study, we determined that in 6 pairs of anatomical material, the distal interosseous membrane is a thin transparent connective tissue structure. No additional formations in the form of thickening were found. In 4 pairs of preparations, which amounted to 40% of the total amount in the distal interosseous membrane, there were additional formations in the form of thickening of the membrane this is the distal oblique bundle and the distal ray-the ulnar tract. During the functional study, it was revealed that during pronation of the forearm, the distal membrane and dorsal capsule are stretched, which in turn holds the head of the ulna in the sigmoid notch of the radius. After conducting ultrasound, we determined the variability in the structure of the distal interosseous membrane of the forearm. The distal oblique bundle is visualized as a linear hyperechoic formation. Of the 30 surveyed, this formation was identified in 13 women (92.8%) and 1 man (7.1%), which in percentage terms was 43%.&#x0D; Conclusion. After conducting anatomical examination, we determined the variability in the structure of the distal interosseous membrane of the forearm in the form of the presence of thickenings the distal oblique bundle and the distal ray-ulnar tract, and determined the effect of these structures on the stability of the distal ray-elbow joint. An ultrasound scan also identified the features in the structure of the distal interosseous membrane in the form of hyperechoic formation.

Isolated volar ulnar dislocation: case report and literature review

Isolated ulnar head dislocation is a rare and frequently misdiagnosed clinical entity. To our knowledge, few cases of volar ulnar dislocation have been reported in literature and a well-defined treatment does not exist. This case report describes the management of an acute isolated volar ulna dislocation in a 64-year-old patient. We also performed a systematic review of the available English literature in order to evaluate management of volar ulna dislocation. Among 86 eligible articles, 13 were included and fully evaluated. Isolated distal radioulnar joint (DRUJ) dislocation with only ligamentous involvement are uncommon injuries. If diagnosis is uncertain and X-ray are not informative, further imaging with CT or MRI can be performed because it is mandatory to recognise these lesions and to manage them properly. The first step is to reduce the DRUJ dislocation. The second is to evaluate the stability of the joint. If multidirectional instability is noted, direct repair of the ligament or Triangular Fibrocartilaginous Complex (TFCC) is indicated. Management of the acute lesion initially consists of an attempt of closed reduction, but if closed reduction is impossible in our opinion the only option is to restore the normal anatomy of the DRUJ with operative treatment. Herein, we summarise the available evidence on this lesion, based on this case and after a systematic review of the literature. We propose operative management for this lesion, with open reduction and reconstruction of ligaments to allow a rapid functional recovery and to avoid secondary complications.

The Outcome of Distal Radius Fractures with Concomitant Injuries Is Similar to those of Isolated Distal Radius Fractures Provided that an Arthroscopically Supported Treatment Is Performed.

Background: Concomitant injuries of distal radius fractures (DRF) can have a fatal impact on the patients’ outcome. However, wrist arthroscopy is a costly and complex procedure. It remains elusive whether patients benefit from an additional arthroscopy. Methods: Patients with a DRF who were treated arthroscopically were enrolled. Fifty-six wrists were evaluated regarding their function by self-assessment with the Munich Wrist Questionnaire (MWQ). Thirty-nine patients were examined for postoperative strength and motion. Concomitant injuries were detected. Results: A total of 75% of the DRF were type C injuries (AO classification). Twenty-four cases (43%) were triangular fibrocartilaginous complex (TFCC) lesion, eight cases (14%) of scapholunate ligament (SL) injuries and seven cases (12%) were a combination of TFCC and SL ligament lesion. No difference in function could be detected between DRF with surgically addressed concomitant lesions and isolated DRF. Dorsalextension, palmarflexion and grip strength were significantly reduced in patients with DRF and concomitant injuries compared to the healthy wrist. However, patients with DRF and arthroscopically treated concomitant injuries had similar results to those suffering only from an isolated DRF. Conclusion: The increased occurrence of concomitant injuries is to be expected in intraarticular DRF. Patients with concomitant injuries benefit from an arthroscopically assisted fracture treatment and show similar results compared to isolated DRF.

Arthroscopic Foveal Reattachment of the Triangular Fibro Cartilaginous Complex.

Background Foveal attachment of the triangular fibrocartilaginous complex (TFCC) is essential for distal radioulnar joint stability. Controversy still exists as to which is the best treatment in case of foveal lesions. Actual arthroscopic techniques either require mini open steps or are complex and expensive. We present a simple all inside knotless repair, providing a strong bony fixation in the fovea. Materials and Methods Through 3-4 and 6R portals, the ulnar fovea is debrided and a wire is passed percutaneously through the TFCC to place a mattress suture at its free end. It is then reattached to the fovea with an impacted anchor. Retrospective Study Between 2013 and 2016, a cohort of 5 patients presenting with isolated Palmer 1B, EWAS 2 lesions of the TFCC were operated on with this technique. Clinical evaluation was based on a compared measurement of the grip strength, pain on a visual analogic scale (VAS), different ranges of motion, and distal radioulnar joint (DRUJ) stability. We also used functional scores: Mayo modified wrist score (MMWS), Quick disability arm, shoulder and hand (DASH), and patient-related wrist evaluation (PRWE). The average follow-up was 29.4 months (range 9-42 months). Results On postoperative evaluation, pain was reduced by 5 points (range 1-9) and grip strength averaged 94% of the unaffected side. Range of motion averaged 92% on the unaffected side. DRUJ instability was slight in 4 patients and mild in 1 patient. MMWS was excellent for 1, good for 1, and satisfactory for 3 patients. Quick Dash averaged 17.68 (range 0-38.6) compared with preoperative average of 59.48 (range 45-77) with an amelioration of 43 (range 34-57). PRWE averaged 20 (range 1-41.5) compared with preoperative average of 60.3 (range 33.5-76.5) with an amelioration of 41 (range 32-58). We reported no complications and particularly no lesions of the dorsal sensory branch of the ulnar nerve. Conclusions We present a simple arthroscopic technique using a single suture anchor placed in the ulnar fovea. Repairs performed with this technique are simple and the results achieved seem to be similar to those obtained with conventional open or arthroscopic techniques, although further investigation with an increased number of patients and follow-up are required. It however became our first choice of treatment in European Wrist Arthroscopy Society (EWAS) 2 lesions of the TFCC.

Scapholunate, lunotriquetral and TFCC ligament injuries associated with intraarticular distal radius fractures: Arthroscopic assessment and correlation with fracture types

The aim of this study was to evaluate the prevalence of arthroscopic scapholunate (SL) and/or lunotriquetral (LQ) laxity and triangular fibrocartilaginous complex (TFCC) injuries in patients who have an intraarticular fracture of the distal radius and to correlate these lesions with fracture type. Fifty-seven intraarticular radius fractures, whether or not they were associated with an ulnar styloid fracture, were evaluated and treated by arthroscopy. Scapholunate and lunotriquetral ligament injuries were classified according to the EWAS classification. TFCC lesions were assessed according to Palmer's classification. Each injury was documented through preoperative X-rays and a CT scan. Fracture type and soft tissue injury were not significantly associated one to another. Arthroscopic examination revealed at least one soft tissue injury in 39 intraarticular fractures of the distal radius (68.4%). Twenty-five percent of arthroscopic SL laxities (including severe EWAS 3 injuries) were not detected on standard radiographs. Arthroscopic SL laxity was present in 8 of 11 cases (72.7%) of radial styloid fracture and in 15 of 25 cases (60%) of fractures with at least one radial styloid component. There was no association between LQ integrity and fracture type. Ulnar styloid fractures (base or tip) and TFCC lesions were significantly correlated (P<0.0001). The prevalence of soft tissue lesions secondary to intraarticular fractures of the distal radius was 68.4%. However, there was no statistically significant relationship between the different types of radius fractures and soft tissue injuries. On the other hand, ulnar styloid fracture was predictive of TFCC injury.

Réinsertion fovéale du complexe triangulaire fibro-cartilagineux purement arthroscopique. Description technique et résultats préliminaires

Foveal attachment of the triangular fibrocartilaginous complex (TFCC) is essential for distal radioulnar joint stability. Controversy still exists as to which is the best treatment in case of foveal lesions. Actual arthroscopic techniques either require mini open steps or are complex and expensive. We present a simple all inside knotless repair providing a strong bony fixation in the fovea. Between 2013 and 2016, a cohort of 5 patients presenting with isolated Palmer 1B, EWAS 2 lesions of the TFCC were operated on with this technique. Clinical evaluations were based on a compared measurement of the grip strength, pain on a visual analogic scale, of the different ranges of motion and distal radioulnar joint (DRUJ) stability. We also used functional scores : Mayo Modified Wrist Score (MMWS), Quick DASH (Disability Arm, shoulder and Hand) and PRWE. The average follow-up was 29.4 months (range 9 to 42 months). Through 3-4 and 6R portals, the ulnar fovea is debrided and a wire is passed percutaneously through the TFCC to place a mattress suture on its free end. It is then reattached to the fovea with an impacted anchor. On postoperative evaluation, pain was reduced of 5 points (range 1 to 9), grip strength averaged 94% of the unaffected side. Range of motion averaged 92% of the unaffected side. DRUJ instability was slight in 4 patients and mild in 1 patient. MMWS was excellent for 1, good for 1 and satisfactory for 3 patients. Quick Dash averaged 17,68 (range 0 to 38.6) compared to preoperative average of 59.48 (range 45 to 77) with an amelioration of 43 (range 34 to 57). PRWE averaged 20 (range 1 to 41.5) compared to preoperative average of 60.3 (range 33.5 to 76.5) with an amelioration of 41 (range 32 to 58). We reported no complications and particularly no lesions of the dorsal sensory branch of the ulnar nerve. Repairs performed with this technique are simple and results achieved seems to be similar to those obtained with conventional open or arthroscopic techniques, although further investigation with an increased number of patients and follow-up are required. We present a simple arthroscopic technique using a single suture anchor placed in the ulnar fovea, which became our first choice of treatment in EWAS 2 lesions of the TFCC.

Réinsertion fovéale du complexe triangulaire fibrocartilagineux purement arthroscopique. Desciption technique et résultats préliminaires

Introduction Foveal attachment of the triangular fibrocartilaginous complex (TFCC) is essential for distal radioulnar joint stability. Controversy still exists as to which is the best treatment in case of foveal lesions. Actual arthroscopic techniques either require mini open steps or are complex and expensive. We present a simple all inside knotless repair providing a strong bony fixation in the fovea. Material and method Operative Techniques: Through 3–4 and 6R portals, the ulnar fovea is debrided and a wire is passed percutaneously through the TFCC to place a mattress suture on its free end. It is then reattached to the fovea with an impacted anchor. Retrospective study Between 2013 and 2016, a cohort of 5 patients presenting with isolated Palmer 1B, EWAS 2 lesions of the TFCC were operated on with this technique. Clinical evaluations were based on a compared measurement of the grip strength, pain on a visual analogic scale, of the different ranges of motion and distal radioulnar joint (DRUJ) stability. We also used functional scores: Mayo Modified Wrist Score (MMWS), Quick DASH (Disability Arm, shoulder and Hand) and PRWE. The average follow up was 29,4 months (range 9 to 42 months). Results On postoperative evaluation, pain was reduced of 5 points (range 1 to 9), grip strength averaged 94 % of the unaffected side. Range of motion averaged 92 % of the unaffected side. DRUJ instability was slight in 4 patients and mild in 1 patient. MMWS was excellent for 1, good for 1 and satisfactory for 3 patients. Quick Dash averaged 17.68 (range 0 to 38.6) compared to preoperative average of 59.48 (range 45 to 77) with an amelioration of 43 (range 34 to 57). PRWE averaged 20 (range 1 to 41.5) compared to preoperative average of 60.3 (range 33.5 to 76.5) with an amelioration of 41 (range 32 to 58). We reported no complications and particularly no lesions of the dorsal sensory branch of the ulnar nerve. Conclusions We present a simple arthroscopic technique using a single suture anchor placed in the ulnar fovea. Repairs performed in this fashion are simple and results achieved seems to be similar to those obtained with conventional open or arthroscopic techniques, although further investigation with an increased number of patients and follow up are required. It however became our first choice of treatment in EWAS 2 lesions of the TFCC.

Clinical and Radiographic Correlates for the Treatment of Ulnocarpal Impaction.

Background Ulnocarpal impaction (UCI) is a described cause of ulnar side wrist pain. Questions Does absolute ulnar variance (UV) or change in UV with grip affect patient-rated outcome scores (PROS) in patients with symptomatic UCI undergoing surgery? Does UV differ between symptomatic and contralateral wrists? Does arthroscopic grade of triangular fibrocartilaginous complex (TFCC) tears and lunotriquetral (LT) ligament tears influence PROS? Do PROS improve following ulnar shortening osteotomy (USO) or wafer procedures and does improvement depend on the amount of shortening or achievement of negative UV? Patients and Methods We analyzed information on patients undergoing USO or wafer procedures for UCI as recorded in a database of prospectively collected information on individuals with ulnar side wrist pain. This included (1) patient-rated wrist evaluation and QuickDASH scores on enrolment, 3 and 12 months postoperatively; (2) standardized bilateral posteroanterior (PA) wrist radiographs, including PA grip views of the symptomatic wrist; and (3) arthroscopic findings. Results Larger changes in UV between PA neutral and grip views prior to surgery were associated with smaller improvements in PROS, 12 months after surgery. Actual UV value before and after surgery did not affect PROS. There was no difference in UV between symptomatic and contralateral wrists. The presence of TFCC or LT ligament tears did not influence PROS. Mean PROS improved postoperatively. Conclusions Ulnar shortening procedures result in improvement in PROS in patients with UCI. Variation in UV with rotation and grip results in variable outcomes. Level of Evidence This is a Level II, cohort study.

Nahttechniken am Diskus

Traumatic ruptures of the triangular fibrocartilaginous complex (TFCC) may cause ulnar-sided wrist pain. These ruptures frequently lead to instability of the distal radioulnar joint (DRUJ) because the ulnoradial ligaments, which are interwoven with the TFCC, are avulsed from the fovea of the ulnar head or-very rarely-from the radius. Conservative treatment may be sufficient, and some instability may be tolerated over time. In the case of persistent pain, operative repair by reattachment of the TFCC and, thereby, the ligaments to the previously debrided bone in the fovea is effective in reestablishing a stable, pain free DRUJ. Several arthroscopic and open repair techniques have been described in the last years. Contraindications such as the ulna-plus-situation or instability due to even minor degrees of malunion after fractures of the forearm bones must be kept in mind.An overview is given of the pathological anatomy, diagnosis, indications and suturing techniques.