scholarly journals Reconstruction for DRUJ Instability

Hand ◽  
2007 ◽  
Vol 2 (3) ◽  
pp. 123-126 ◽  
Author(s):  
Ericka Lawler ◽  
Brian D. Adams
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Senior Author ◽  
Triangular Fibrocartilage Complex ◽  
Radius Of Curvature ◽  
Anatomical Studies ◽  
Ulnar Head ◽  
Sigmoid Notch ◽  
Triangular Fibrocartilage ◽  
Inherent Stability

The skeletal architecture of the DRUJ provides minimal inherent stability, as the sigmoid notch is shallow and its radius of curvature is 50% greater than that of the ulnar head [Af Ekenstam F, Hagert CG. Anatomical studies on the geometry and stability of the distal radio ulnar joint. Scand J Plast Reconstr Surg 1985;19(1):17–25]. Due to its incongruent articulation, the DRUJ relies strongly on the surrounding soft tissues for stability. The triangular fibrocartilage complex (TFCC) is generally accepted as the major soft tissue stabilizer of the DRUJ of which the volar and dorsal radioulnar ligaments are the primary components. Restoration of the radioulnar ligaments offers the best possibility to restore the normal DRUJ primary constraints and kinematics. This article presents an update of the procedure developed by the senior author that anatomically reconstructs the palmar and dorsal radioulnar ligaments at their anatomic origins and insertions.

The Carpal Detachment Injury of the Triangular Fibrocartilage Complex

2002 ◽  
Vol 27 (1) ◽  
pp. 86-89 ◽  
Author(s):  
S. NISHIKAWA ◽  
S. TOH ◽  
H. MIURA ◽  
K. ARAI
Keyword(s):  
Soft Tissue ◽  
Conservative Therapy ◽  
Articular Surface ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Arthroscopy ◽  
Ulnar Side ◽  
Arthroscopic Findings ◽  
Triangular Fibrocartilage

Triangular fibrocartilage complex (TFCC) injuries were suspected clinically in 22 wrists of 21 patients, but arthrography and MRI assessments of this structure were normal. As conservative therapy for 2 months did not improve their symptoms, wrist arthroscopy was then performed. Although no abnormalities of the TFCC and ligaments were observed, meniscus homologue-like tissue which arose from TFCC was riding on the articular surface of the triquetrum. After resection of this soft tissue with a shaver and a punch, the symptoms disappeared in all cases. The arthroscopic findings suggested that a portion of TFCC that was originally attached to the ulnar side of the triquetrum had become detached.

scholarly journals A three-dimensional virtual morphometry study of the sigmoid notch of the distal radius

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880250 ◽  
Author(s):  
Sachin Shivdas ◽  
MS Hashim ◽  
T Sara Ahmad
Keyword(s):  
Distal Radius ◽  
Three Dimensional ◽  
Radius Of Curvature ◽  
Ulnar Head ◽  
Sigmoid Notch ◽  
Morphological Variants ◽  
The Right ◽  
Ulnar Head Prosthesis ◽  
Ethnic Variations ◽  
Morphological Patterns

Purpose: Our primary objectives were to create a reliable, noninvasive method for three-dimensional morphometry of deep bony parameters within the sigmoid notch of the distal radius, to identify its morphological patterns, and to identify any significant variation between the left and the right wrists. Our secondary objectives were to obtain morphometric values that could represent our population and to identify any possible ethnic variations. Methods: Computed tomography scans of 102 wrists from 51 healthy individuals were analyzed using a virtualization software. Four anatomical parameters at the distal radius sigmoid notch, namely, the radius of curvature, depth, version angle, and sagittal slope were measured. Morphological patterns of the sigmoid notch surface were identified. The results were statistically analyzed to assess the reliability of the technique and were compared with previously published literature. Results: Comparing our findings with previously published values, our study revealed a slightly larger radius of curvature and sagittal slope, while revealing a smaller depth and version. We identified the S-type, C-type, and ski-slope morphological variants. The flat-face morphological variant, however, was not identified. The sigmoid notch at the left and right wrists were similar, except for the radius of curvature. Conclusion: This study demonstrates a noninvasive, fast, reliable, and reproducible technique for analyzing the sigmoid notch of the distal radius. In wrist injuries with intact distal radius sigmoid notch but involving comminuted fractures of the ulnar head, ulnar head replacement may be indicated. In such cases, analysis of the ipsilateral intact sigmoid notch would allow us to prepare an ulnar head prosthesis of appropriate size.

scholarly journals Can the Diagnostics of Triangular Fibrocartilage Complex Lesions Be Improved by MRI-Based Soft-Tissue Reconstruction? An Imaging-Based Workup and Case Presentation

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Niels Hammer ◽  
Ulrich Hirschfeld ◽  
Hendrik Strunz ◽  
Michael Werner ◽  
Thomas Wolfskämpf ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Three Dimensional ◽  
Triangular Fibrocartilage Complex ◽  
Soft Tissue Reconstruction ◽  
Case Presentation ◽  
Complex Anatomy ◽  
Radiocarpal Joint ◽  
Tissue Reconstruction ◽  
Triangular Fibrocartilage ◽  
Magnetic Resonance Imaging Mri

Introduction. The triangular fibrocartilage complex (TFCC) provides both mobility and stability of the radiocarpal joint. TFCC lesions are difficult to diagnose due to the complex anatomy. The standard treatment for TFCC lesions is arthroscopy, posing surgery-related risks onto the patients. This feasibility study aimed at developing a workup for soft-tissue reconstruction using clinical imaging, to verify these results in retrospective patient data. Methods. Microcomputed tomography (μ-CT), 3 T magnetic resonance imaging (MRI), and plastination were used to visualize the TFCC in cadaveric specimens applying segmentation-based 3D reconstruction. This approach further trialed the MRI dataset of a patient with minor radiological TFCC alterations but persistent pain. Results. TFCC reconstruction was impossible using μ-CT only but feasible using MRI, resulting in an appreciation of its substructures, as seen in the plastinates. Applying this approach allowed for visualizing a Palmer 2C lesion in a patient, confirming ex postum the arthroscopy findings, being markedly different from MRI (Palmer 1B). Discussion. This preliminary study showed that image-based TFCC reconstruction may help to identify pathologies invisible in standard MRI. The combined approach of μ-CT, MRI, and plastination allowed for a three-dimensional appreciation of the TFCC. Image quality and time expenditure limit the approach’s usefulness as a diagnostic tool.

ARTHROSCOPIC WAFER PROCEDURE

Hand Surgery ◽  
1998 ◽  
Vol 03 (02) ◽  
pp. 225-235
Author(s):  
Toshihiko Imaeda ◽  
Ryogo Nakamura ◽  
Kenji Tsunoda ◽  
Kentaro Watanabe
Keyword(s):  
Minimally Invasive ◽  
Invasive Procedure ◽  
Triangular Fibrocartilage Complex ◽  
Ulnar Variance ◽  
Minimally Invasive Procedure ◽  
Ulnar Head ◽  
Mayo Wrist Score ◽  
Triangular Fibrocartilage

Thirteen of 15 patients with ulnocarpal abutment syndrome who underwent an arthroscopic wafer procedure since 1991 were seen in follow-up at least six months postoperatively. An arthroscopic wafer procedure was performed during which the triangular fibrocartilage complex (TFCC) was partially removed with a blade and a basket punch was made through the 4–5 arthroscopic portal. The ulnar head was then partially removed with a motorized burr through the 4–5 or 6R portal. The modified Mayo wrist score was used to evaluate the results. Four wrists produced excellent results; six wrists, good; two wrists, fair; and one wrist, poor. The wrists with a null or negative ulnar variance after the procedure achieved a better result than those with a remaining positive ulnar variance at the most prominent as well as at the deepest level of the resected ulna. The arthroscopic wafer procedure offers the benefits of a minimally invasive procedure; however, it is technically demanding to remove the ulnar head with a negative ulnar variance at the most prominent level as well as at the deepest level of the resected ulnar head.

Restricted Wrist Rotation after an Ulnar Head Fracture: A Report of Two Cases

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Koji Abe ◽  
Kazuki Sato ◽  
Toshiyasu Nakamura
Keyword(s):  
Range Of Motion ◽  
Soft Tissues ◽  
Surgical Intervention ◽  
Restricted Range ◽  
Case Description ◽  
Rare Entity ◽  
Loose Bodies ◽  
Ulnar Head ◽  
Triangular Fibrocartilage ◽  
Restriction Of Range

Abstract Background Isolated ulnar head fracture is a rare entity, and the restriction of range of motion in the wrist is rarely reported. Case Description We report two cases of conservatively treated ulnar head malunion with restricted supination and pronation. The increased tension of the volar portion of the triangular fibrocartilage complex was observed, and the surgical treatment significantly improved the range of motion. Literature Review There are a few reports on isolated ulnar head fracture. Other causes of restricted supination and pronation of the wrist are mostly due to the interposition of soft tissues or loose bodies. Clinical Relevance Malunion after ulnar head fracture can cause restriction of wrist supination and pronation. Surgical intervention may be considered if restricted range of motion remains after conservative treatment.

Distal radioulnar joint stability measured with radiostereometry during the piano key test

2020 ◽  
Vol 45 (9) ◽  
pp. 923-930 ◽  
Author(s):  
Janni Kjærgaard Thillemann ◽  
Sepp De Raedt ◽  
Peter Bo Jørgensen ◽  
Lone Rømer ◽  
Torben Bæk Hansen ◽  
...  
Keyword(s):  
Interobserver Reliability ◽  
Distal Radioulnar Joint ◽  
Cadaver Study ◽  
Triangular Fibrocartilage Complex ◽  
Joint Stability ◽  
Human Donor ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Custom Made ◽  
Triangular Fibrocartilage

Distal radioulnar joint instability is difficult to grade by clinical examination and interobserver reliability is low. This study used a new and precise radiostereometry method for measurement of distal radioulnar joint translation. Eight human donor arms were positioned in a custom-made fixture and a standardized piano key test was done with pressure on the ulnar head. Examination was done before and after dividing the styloid and foveal insertions of the triangular fibrocartilage complex. In the intact wrists, the piano key test induced a mean 1.36 mm translation of the ulnar head, which increased statistically significantly to 1.96 mm after a lesion of the styloid ligament insertion and to 2.3 mm after combined lesions of the styloid and foveal ligament insertions. This experimental cadaver study demonstrates a radiological method for precise quantification of distal radioulnar joint stability after different grades of triangular fibrocartilage complex injury.

Application of force-monitor ultrasonography to assess distal radioulnar joint instability in patients with triangular fibrocartilage complex injury

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110383
Author(s):  
Hiroshi Yuine ◽  
Yuichi Yoshii ◽  
Koichi Iwai ◽  
Tomoo Ishii ◽  
Hideki Shiraishi
Keyword(s):  
Dorsal Surface ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Healthy Controls ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Force Ratio ◽  
Triangular Fibrocartilage ◽  
Relationship Of ◽  
Force Displacement

Introduction In this study, we evaluated the differences and measurement accuracy in the force–displacement relationship of the distal radioulnar joint (DRUJ) between patients with triangular fibrocartilage complex (TFCC) injury and healthy controls using force-monitor ultrasonography. Methods This study included 11 TFCC injury patients and 22 healthy controls. We evaluated differences in the force–displacement relationship of the DRUJ in these patients using force-monitor ultrasonography. Cyclic compression was applied to the dorsal surface of the ulnar head. Distance between the dorsal surface of the distal radius and ulnar head at the DRUJ level was measured in the initial and pressed-down positions. Changes in radioulnar displacement, applied force, and displacement-to-force ratio were measured. Furthermore, we compared the parameters between the affected and unaffected wrists and between TFCC injury patients and controls. Results The radioulnar displacement and displacement-to-force ratio were significantly larger in the affected wrists than in the unaffected wrists ( P =  0.003 and P =  0.02). The affected/unaffected side ratio of radioulnar displacement and displacement-to-force ratio were significantly larger in the TFCC injury patients than in the controls ( P =  0.003 and P =  0.02). The area under the curve was 0.82 for the affected/unaffected ratio of the radioulnar displacement. The optimal cutoff value indicated by the receiver-operating characteristic curve for the affected/unaffected ratio of the radioulnar displacement was 1.71; the sensitivity and specificity were 82% and 86%, respectively. Conclusions Assessing the DRUJ instability with force-monitor ultrasonography may help identify TFCC-injured wrists.

Reconstructed animation from four-phase grip MRI of the wrist with ulnar-sided pain

2013 ◽  
Vol 38 (7) ◽  
pp. 746-750 ◽  
Author(s):  
T. Oda ◽  
T. Wada ◽  
K. Iba ◽  
M. Aoki ◽  
M. Tamakawa ◽  
...  
Keyword(s):  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Pain ◽  
Articular Disc ◽  
Ulnar Head ◽  
Dynamic Variations ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Ulnar Wrist Pain ◽  
Triangular Fibrocartilage

In order to visualize dynamic variations related to ulnar-sided wrist pain, animation was reconstructed from T2* coronal-sectioned magnetic resonance imaging in each of the four phases of grip motion for nine wrists in patients with ulnar pain. Eight of the nine wrists showed a positive ulnar variance of less than 2 mm. Ulnocarpal impaction and triangular fibrocartilage complex injury were assessed on the basis of animation and arthroscopy, respectively. Animation revealed ulnocarpal impaction in four wrists. In one of the four wrists, the torn portion of the articular disc was impinged between the ulnar head and ulnar proximal side of the lunate. In another wrist, the ulnar head impacted the lunate directly through the defect in the articular disc that had previously been excised. An ulnar shortening osteotomy successfully relieved ulnar wrist pain in all four cases with both ulnocarpal impaction and Palmer’s Class II triangular fibrocartilage complex tears. This method demonstrated impairment of the articular disc and longitudinal instability of the distal radioulnar joint simultaneously and should be of value in investigating dynamic pathophysiology causing ulnar wrist pain.

Dorsoradial Avulsion of the Triangular Fibrocartilage Complex with an Avulsion Fracture of the Sigmoid Notch of the Radius

2007 ◽  
Vol 32 (6) ◽  
pp. 705-708 ◽  
Author(s):  
Y. MORISAWA ◽  
T. NAKAMURA ◽  
K. TAZAKI
Keyword(s):  
Avulsion Fracture ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Bone Fragment ◽  
Anatomical Reduction ◽  
Avulsion Injury ◽  
Radioulnar Joint ◽  
Sigmoid Notch ◽  
Dorsal Portion ◽  
Triangular Fibrocartilage

We report two extremely rare cases of dorsal radial avulsion injury of the triangular fibrocartilage complex accompanied by an avulsion fracture of the sigmoid notch of the radius. Anatomical reduction of the bone fragment in conjunction with reattachment of the dorsal portion of the radioulnar ligament to the radial sigmoid notch were necessary to restore stability of the distal radioulnar joint and tension of the triangular fibrocartilage proper.

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