A New Technique of Reattachment after Traumatic Avulsion of the TFCC at Its Ulnar Insertion

1995 ◽  
Vol 20 (2) ◽  
pp. 178-184 ◽  
Author(s):  
G. R. SENNWALD ◽  
M. LAUTERBURG ◽  
V. ZDRAVKOVIC
Keyword(s):  
Functional Results ◽  
Biomechanical Properties ◽  
Ulnar Head ◽  
Shortening Osteotomy ◽  
Degree Of Satisfaction ◽  
Triangular Fibrocartilage ◽  
Male Patients ◽  
A New Technique ◽  
Previous Occupation

One female and seven male patients (median age 25.5) presented with traumatic avulsion of the triangular fibrocartilage complex (TFCC), type 1B according to Palmer’s classification. Reattachment of the TFCC near its anchoring point was combined with an intraarticular shortening osteotomy of the ulnar head. This provides an excellent approach to the TFCC and a well vascularized anchoring surface. The mooring point is biomechanically appropriate and the tissues with the best biomechanical properties are used. The functional results with a mean follow-up of 3 years were encouraging, as demonstrated by the significant improvement of pain ( P = 0.017). All patients were able to return to their previous occupation; no further surgery was necessary to the distal radio-ulnar joint and no impairment of pronation and supination was detected. The final wrist score reflects the subjective results defined by the patient. However the correlation is not linear and the wrist scores are superior to the degree of satisfaction defined by the patient.

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.

Arthroscopic treatment of triangular fibrocartilage complex injuries in paediatric and adolescent patients

2019 ◽  
Vol 44 (6) ◽  
pp. 582-586 ◽  
Author(s):  
Samir K. Trehan ◽  
Gregory Schimizzi ◽  
Tony S. Shen ◽  
Lindley B. Wall ◽  
Charles A. Goldfarb
Keyword(s):  
Parent Satisfaction ◽  
Subsequent Treatment ◽  
Triangular Fibrocartilage Complex ◽  
Level Of Evidence ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Adolescent Patients ◽  
Triangular Fibrocartilage ◽  
Complex Surgery

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

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.

scholarly journals Application of Periareolar Mammaplasty with the Tissue Folding Technique in Breast Reshaping following Polyacrylamide Hydrogel Removal

Breast Care ◽  
2019 ◽  
Vol 15 (2) ◽  
pp. 157-162
Author(s):  
Yantao Cai ◽  
Bin Liu ◽  
Mingjuan Liao ◽  
Liu He ◽  
Chenfang Zhu
Keyword(s):  
Augmentation Mammoplasty ◽  
Polyacrylamide Hydrogel ◽  
Breast Ptosis ◽  
Degree Of Satisfaction ◽  
Breast Reshaping ◽  
Breast Shape ◽  
A New Technique ◽  
Periareolar Mammaplasty ◽  
Implantation Method

Background: Polyacrylamide hydrogel (PAAG) was used as an injectable implant for augmentation mammoplasty for over 30 years, but its use was ceased due to various related complications. The only way to treat these complications is PAAG removal, but this causes breast ptosis, nipple retraction, breast asymmetry, and skin laxity. Objectives: This article reports a new technique for breast reshaping after PAAG removal without prosthesis implantation. Method: From January 2015 to June 2018, twenty-three patients underwent periareolar mammoplasty with the tissue folding technique (PMTFT) for breast reshaping after PAAG removal. Postoperative breast shape and the degree of satisfaction of the patients were evaluated during follow-up. Results: All patients recovered well without severe complications. All patients were satisfied with their postoperative breast shape and their symptoms were relieved after surgery. Conclusions: PMTFT provides satisfactory postoperative breast shape results. Economical, practical, and technical advantages were found over traditional prosthesis-mediated breast reconstruction. PMTFT can be an ideal surgical choice in appropriate cases.

scholarly journals FUNCTIONAL RESULTS POST-TRIANGULAR FIBROCARTILAGE COMPLEX RECONSTRUCTION WITH EXTENSOR CARPI ULNARIS WITH OR WITHOUT ULNAR SHORTENING IN CHRONIC DISTAL RADIOULNAR JOINT INSTABILITY

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 169-176 ◽  
Author(s):  
Jui-Tien Shih ◽  
Hung-Maan Lee
Keyword(s):  
Functional Results ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Radioulnar Joint ◽  
Extensor Carpi Ulnaris ◽  
Druj Instability ◽  
Sport Activities ◽  
Triangular Fibrocartilage ◽  
Post Traumatic

From September 1996 to September 2001, 37 adult patients were diagnosed with chronic triangular fibrocartilage complex (TFCC) tears with distal radioulnar joint (DRUJ) instability in our clinic. They had all received the procedure of TFCC reconstruction with partial extensor carpi ulnaris (ECU) combined with or without ulnar shortening. There were 36 males and one female in the study with a mean age of 22.4 years. The follow-up period ranged from 25 to 48 months with a mean of 36.2 months. All patients received the rehabilitation programme and were re-examined at our outpatient department. The results were graded according to the Mayo Modified Wrist Score. Eleven of the 37 patients rated their wrists "excellent", 22 rated "good", and four rated "fair". Overall, a total of 33 patients (89%) rated satisfactorily and returned to work or sport activities. Therefore, TFCC reconstruction with partial ECU tendon combined with or without ulnar shortening procedure is an effective method for post-traumatic chronic TFCC tears with DRUJ instability suggested by this study.

Long-Term Follow-Up of Surgical Correction of Madelung’s Deformity with Conservation of the Distal Radioulnar Joint in Teenagers

2000 ◽  
Vol 25 (1) ◽  
pp. 22-25 ◽  
Author(s):  
A. SALON ◽  
M. SERRA ◽  
J. C. POULIQUEN
Keyword(s):  
Distal Radioulnar Joint ◽  
Surgical Correction ◽  
Wedge Osteotomy ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Shortening Osteotomy ◽  
Long Term Follow Up ◽  
Madelung’S Deformity

Eleven wrists with painful Madelung deformity in seven patients were corrected during adolescence by a closing wedge osteotomy of the radius and a shortening osteotomy of the ulna, with conservation of the distal radioulnar joint. At late follow-up (9.7 years) function was considerably improved. When the ulnar head was correctly relocated during operation, a new distal radioulnar space developed. Shortening of the ulna must be generous and combined with slight flexion at the osteotomy.

scholarly journals Treatment of Ulnar Impaction Syndrome with and without Central TFC Lesion

2017 ◽  
Vol 07 (02) ◽  
pp. 133-140 ◽  
Author(s):  
Alexandra Herold ◽  
Frank Unglaub ◽  
Kai Megerle ◽  
Holger Erne ◽  
Steffen Löw
Keyword(s):  
Wrist Pain ◽  
Level Of Evidence ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Significant Difference ◽  
Triangular Fibrocartilage ◽  
Improved Function ◽  
Ulnar Impaction Syndrome

Background Arthroscopic debridement of the triangular fibrocartilage (TFC) is well accepted in patients with ulnar impaction syndrome with central TFC lesions. Treatment remains controversial, however, when there is no such lesion from radiocarpal view. Purpose This study assessed the clinical outcome of arthroscopic central TFC resection and debridement and secondary ulnar shortening in patients with ulnar impaction with central TFC lesion compared with patients without TFC lesion. Patients and Methods Thirty-two consecutive patients with ulnar impaction syndrome were arthroscopically treated, 16 of whom had a central lesion of the TFC that was debrided. In the 16 patients with no lesion from the radiocarpal view, the TFC was centrally resected and debrided to decompress the ulnocarpal joint. Persisting symptoms necessitated ulnar shortening in four patients in each group. Two patients underwent repeat arthroscopic TFC debridement. All patients were examined at 3, 6, and 12 months, and at final follow-up (mean: 1.7 years) following arthroscopy, respectively ulnar shortening or hardware removal. Results In both groups, pain, Krimmer, and DASH scores significantly improved. Improvements of DASH scores were significantly higher in patients without lesion at 12 months and at final follow-up. For other parameters, no significant difference was found between the two groups. Conclusion In both situations, with and without central TFC lesion, resection and debridement sufficiently reduced the ulnar-sided wrist pain and improved function in three out of four patients, and therefore qualified as the first-line treatment of ulnar impaction syndrome as arthroscopy is performed, anyway. Those patients who complained of persisting or recurrent ulnar-sided wrist pain finally benefitted from ulnar shortening osteotomy as the secondary procedure. Level of Evidence Therapeutic III, case–control study.

A STUDY OF FUNCTIONAL OUTCOMES FOLLOWING IMPLANTATION OF A TOTAL DISTAL RADIOULNAR JOINT PROSTHESIS

2008 ◽  
Vol 33 (1) ◽  
pp. 18-28 ◽  
Author(s):  
L. A. LAURENTIN-PÉREZ ◽  
A. N. GOODWIN ◽  
B. A. BABB ◽  
L. R. SCHEKER
Keyword(s):  
Functional Outcomes ◽  
Weight Bearing ◽  
Distal Radioulnar Joint ◽  
Joint Prosthesis ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Long Term Follow Up ◽  
Triangular Fibrocartilage

This paper reports a long-term follow-up measuring pain, range of motion and weight-bearing ability, following implantation of a total distal radioulnar joint prosthesis. This prosthesis differs from excision arthroplasties and ulnar head replacements by replacing all three components of the distal radioulnar joint, viz. the sigmoid notch, the ulnar head and the triangular fibrocartilage. The design allows longitudinal migration of the radius throughout pronation and supination, as well as load bearing of the wrist. Thirty-one patients receiving the prosthesis returned or were interviewed by telephone at a mean of 5.9 (range 4–9) years. Pronation increased from a mean of 65.5° (range 5–90°) to 74° (range 20–90°) and supination from 53° (range 5–90°) to 70° (range 20–90°) while greatly diminishing and/or eliminating pain. Grip increased from a mean of 10 kg (22 lbs) to 24 kg (52 lbs). Weight bearing was restored or increased in 29 of 31 patients.

Outcome of Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

2020 ◽  
Vol 19 (2) ◽  
pp. 64-68
Author(s):  
Mrinmoy Biswas ◽  
Sudip Das Gupta ◽  
Mohammed Mizanur Rahman ◽  
Sharif Mohammad Wasimuddin
Keyword(s):  
Urethral Stricture ◽  
Flow Rate ◽  
Surgical Outcome ◽  
Simple Technique ◽  
Anterior Segment ◽  
Maximum Flow ◽  
Anastomotic Site ◽  
Buccal Mucosal Graft ◽  
Male Patients

Objective: To assess the success of BMG urethroplasty in long segment anterior urethral stricture. Method: From January 2014 to December 2015, twenty male patients with long anterior segment urethral stricture were managed by BMG urethroplasty. After voiding trial they were followed up at 3 month with Uroflowmetry, RGU & MCU and PVR measurement by USG. Patients were further followed up with Uroflowmetry and PVR at 6 months interval.Successful outcome was defined as normal voiding with a maximum flow rate >15ml /sec and PVR<50 ml with consideration of maximum one attempt of OIU after catheter removal. Results: Mean stricture length was 5.2 cm (range 3-9 cm) and mean follow-up was 15.55 months (range 6-23 months). Only two patients developed stricture at proximal anastomotic site during follow-up. One of them voided normally after single attempt of OIU. Other one required second attempt of OIU and was considered as failure (5%). Conclusion: BMG urethroplasty is a simple technique with good surgical outcome. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.64-68

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