Triangular Fibrocartilaginous Complex Research Articles

Les lésions ligamentaires intracarpiennes associées aux fractures du poignet: Étude prospective radio-clinique sur 40 cas

Purpose of the study We performed a prospective study to search for arthrographic signs in favor of intracarpal ligament lesions occurring concomitantly with wrist fractures. We looked for a relationship between type of fracture and displacement and examined their impact on early functional outcome. Material and methods The series included 40 patients treated over a 1-year period. All 40 patients had a displaced wrist fracture requiring surgical treatment. A three-phase arthrography was performed during the initial operation in order to search for injuries involving the scapho-lunate, luno-pyramidal or triangular complex ligaments. A second arthrography was performed at the time the osteosynthesis material was removed. All patients were followed one year postperatively. Functional outcome was recorded at one year. Results Abnormal images were found in 57% of the patients at the first arthrography. Injury to the triangular complex predominated, followed by combined injuries. There was no statistical correlation between type of fracture, degree of displacement, and presence of ligament lesions (p > 0.05). Lesions of the triangular fibrocartilaginous complex (TFCC) were significantly increased (p = 0.04) in the event of intra-articular fracture. Age and gender did not influence ligament injury. At one year, the functional outcome was statistically comparable between patients with and without ligament injury. At the second arthrography, we observed only five cases where cure of the luno-pyramidal ligament had been achieved. Discussion Intracarpal ligament injuries associated with wrist fractures are frequent. Age had no effect on occurrence of ligament injury in our series, similar to findings reported by others. Likewise, the type of fracture had no effect. Data in the literature show that intra-articular fractures and highly-displaced fractures aggravate ligament injury. Our functional results at one year did not demonstrate any significant difference in patients with and without ligament injury. A 3 or 5-year follow-up might provide further insight. Nevertheless, neglected scapho-lunate lesions still have a bad reputation in the literature, leading us to search for such lesions and to provide adapted treatment in all patients aged less than 50 years presenting a displaced fracture of the wrist.

Assessment of the position of the distal portion of the ulna in lateral projection radiographs of the wrist: analysis of the influence of pronation-supination and flexion-extension on the pisoscaphoid and the ulnotriquetral distances: a cadaver study.

Accurate assessment of the distal radioulnar joint is of paramount importance for the detection of possible dislocation or subluxation. Using a cadaveric model, the authors attempted to establish a quantitative method that would allow identification of normal and abnormal distal radioulnar joint anatomy on well-positioned and rotated conventional radiographs. Four cadaveric wrists, in which subsequent sectioning confirmed the absence of disease, and one cadaveric wrist with a circumscribed lesion of the triangular fibrocartilaginous complex were studied. Defined movements in flexion and extension (+/- 10 degrees, 20 degrees, 30 degrees ) and in pronation and supination (+/- 10 degrees, 20 degrees, 30 degrees ) as well as combined flexion/extension and pronation/supination were performed. The ulnotriquetral and the pisoscaphoid distances were assessed in each position. Correlation with cryosections was achieved. A strong linear correlation between the degree of pronation or supination and the pisoscaphoid and ulnotriquetral distances was noted. Flexion and extension produced no significant effect on the pisoscaphoid distance, but a defined shift of the ulnotriquetral distance occurred with increasing flexion and extension. If all parameters are taken into account, this correlation aids in estimating the degree of possible malpositioning of the wrist during radiography and the degree of subluxation of the distal radioulnar joint. Tabular data with parameters to correct for instances of malrotated images and to estimate the extent of dislocation or malrotation of the distal radioulnar joint are provided.

Arthroscopically assisted osteosynthesis of distal intraarticular radius fractures

Closed reduction and internal fixation of intraarticular distal radial fractures under direct vision of the articular surfaces. Concomitant control of additional carpal injuries and, if necessary, minimally invasive treatment. Distal, intraarticular radial fractures, particularly of group B and C according to the AO fracture classification. Fractures of group A with marked displacement with probable suspected additional carpal injuries, such as of scapholunar and lunotriquetral ligaments, triangular fibrocartilaginous complex. Open fractures, polytrauma patients, comminuted intraarticular fractures. Closed reduction of fracture. Arthrography of the wrist. Exact reduction of the fragments under arthroscopic control. Stabilization of fragments with the help of percutaneously introduced Kirschner wires and/or cannulated screws. If required, temporary arthrodesis of the scapholunar joint, or resection or reattachment of the articular disc. Thirty patients were treated with the described method, 23 of them showed additional injuries. Twenty-three patients who had surgery at least a year before were followed up at an average of 32.5 months (12 to 48) and were assessed according to the point score of Cooney. An excellent or good result was seen in 16 patients, a satisfactory result in 4 and a poor result in 3 patients. A transient paresthesia was noted in 3 patients, in 1 patient we observed an irritation of the extensor pollicis longus. Two patients required revision surgery: 1 shortening of the ulna, 1 plate fixation of the radius.

Wear patterns of the articular cartilage and triangular fibrocartilaginous complex of the wrist: A cadaveric study

The incidence and patterns of degenerative changes within the radio-carpal joint were studied in 138 specimens of elderly cadaveric wrists. Articular cartilage wear of varying severity was seen on the distal radial and ulnar articular surfaces in 27% of cases and on the proximal row articular surfaces in 54%. Wear was most commonly seen on the radial styloid and corresponding area of the scaphoid. The triangular fibrocartilaginous complex (TFCC) was found to be degenerate or torn in 24%. Central degenerative perforation was commonly associated with articular cartilage wear on the ulnar head and the ulnar half of the Innate. No significant wear pattern was seen in those wrists with peripheral linear (i.e. traumatic) TFCC tears. Interosseous scapho-lunate and luno-triquetral ligament disruptions were found in less than 10%, suggesting that disruption of these ligaments is usually traumatic and not degenerative.

Ulnar shortening for tears of the triangular fibrocartilaginous complex

Ten consecutive patients had their ulnas shortened for treatment of ulnar wrist pain associated with triangular fibrocartilaginous complex tears. Each injury was traced to a previous fall or an overuse syndrome. Conservative treatment failed. In all patients, x-ray films showed ulnar positive or neutral variance. The ulna was shortened an average of 2 mm. Frank ulnolunate abutment and/or cartilage degeneration was found in six cases. Follow-up averaged 23 months, and except for one patient in whom radiocarpal arthritis developed, the remaining patients were satisfied and returned to their work or previous level of activity. Relief of pain, grip strength, and range of motion were excellent, except for an average decrease in flexion of 25.8 degrees ( p = 0.01). Hardware irritation was noted in six patients. These findings substantiate the use of ulnar shortening to relieve ulnolunate impingement in patients with ulnar positive or neutral wrists in whom ulnar wrist pain develops and who demonstrate triangular fibrocartilaginous complex tears after acute trauma and/or overuse syndromes.