Management of Peripheral Triangular Fibrocartilage Complex Tears in the Ulnar Positive Patient: Arthroscopic Repair Versus Ulnar Shortening Osteotomy

We assessed outcomes of 43 paediatric and adolescent patients (44 wrists) undergoing arthroscopic triangular fibrocartilage complex surgery by a single surgeon between 2003 and 2016. Medical records were reviewed for clinical, imaging, and operative data. Preoperatively, 49% of patients had additional diagnoses and mean QuickDASH was 47. Patients were telephoned to assess current wrist pain, subsequent treatment(s), satisfaction, and to complete QuickDASH and Patient-Rated Wrist Evaluation questionnaires. Twenty-five patients responded with mean follow-up of 70 months (minimum 13 months). In those patients not reached by telephone, mean clinical follow-up was 21 months. Seven patients had subsequent surgery (most commonly ulnar shortening osteotomy); this was associated with lower satisfaction scores. At final follow-up, mean QuickDASH was 4, Patient-Rated Wrist Evaluation 8 and patient and parent satisfaction scores were 9 and 9 out of 10, respectively. In conclusion, arthroscopic triangular fibrocartilage complex treatment in paediatric patients yielded favourable outcomes and patient/parent satisfaction. Level of evidence: IV

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Repair of the Triangular Fibrocartilage Complex After Ulnar-Shortening Osteotomy: Second-Look Arthroscopy

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2007.01.013 ◽

2007 ◽

Vol 32 (4) ◽

pp. 445-449 ◽

Cited By ~ 30

Author(s):

Masahiro Tatebe ◽

Emiko Horii ◽

Etsuhiro Nakao ◽

Takaaki Shinohara ◽

Toshihiko Imaeda ◽

...

Keyword(s):

Triangular Fibrocartilage Complex ◽

Second Look ◽

Ulnar Shortening Osteotomy ◽

Shortening Osteotomy ◽

Triangular Fibrocartilage

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

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413476979 ◽

2013 ◽

Vol 38 (7) ◽

pp. 746-750 ◽

Cited By ~ 5

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.

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