scholarly journals Surgical Repair of Acute TFCC Injury

Hand ◽  
2019 ◽  
Vol 15 (5) ◽  
pp. 674-678
Author(s):  
John C. Dunn ◽  
Michael M. Polmear ◽  
Leon J. Nesti
Keyword(s):  
Joint Instability ◽  
Surgical Repair ◽  
Distal Radioulnar Joint ◽  
Common Source ◽  
High Demand ◽  
Patient Centered ◽  
Radioulnar Joint ◽  
Wrist Instability ◽  
Outcome Scores ◽  
Triangular Fibrocartilage

Triangular fibrocartilage complex tears are a common source of ulnar-sided wrist pain and distal radioulnar joint instability. Symptoms recalcitrant to conservative management or injuries in high-demand athletes may indicate surgical management. Both open and arthroscopic techniques offer improvements in objective measures, patient-centered outcome scores, and return to work, but may be complicated by nerve irritation, persistent wrist instability, and pain. Recently developed knotless arthroscopic techniques are not well studied but may limit morbidity.

Surgical treatment of acute distal radioulnar joint instability associated with distal radius fractures

2015 ◽  
Vol 40 (8) ◽  
pp. 783-789 ◽  
Author(s):  
H. S. Gong ◽  
H. E. Cho ◽  
J. Kim ◽  
M. B. Kim ◽  
Y. H. Lee ◽  
...  
Keyword(s):  
Distal Radius ◽  
Joint Instability ◽  
Surgical Repair ◽  
Early Mobilization ◽  
Distal Radioulnar Joint ◽  
Volar Plating ◽  
Radius Fractures ◽  
Ulnar Styloid ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage

This study investigates the question of whether open repair of acute distal radioulnar joint instability at the time of volar plating of distal radius fractures would enable early mobilization of the wrist without the risk of distal radioulnar joint instability. We evaluated 29 patients of mean age 53 years with a distal radius fracture and acute distal radioulnar joint instability who underwent volar plating of the radius combined with surgical repair of the triangular fibrocartilage complex or an ulnar styloid base fracture, followed by active motion exercise of the wrist at 1 week after surgery. At 1 year after treatment, all patients had a stable distal radioulnar joint and grip strength averaged 90% of the normal side. This study demonstrates that surgical repair of the triangular fibrocartilage complex or ulnar styloid fracture followed by early mobilization did not result in distal radioulnar joint instability, and suggests that the surgical treatment of distal radioulnar joint instability may permit early mobilization of the wrist in patients who are considered suitable for rapid rehabilitation after surgery. Type of study: Therapeutic Level IV

Patients with triangular fibrocartilage complex injuries and distal radioulnar joint instability have reduced rotational torque in the forearm

2016 ◽  
Vol 41 (7) ◽  
pp. 732-738 ◽  
Author(s):  
J. K. Andersson ◽  
P. Axelsson ◽  
J. Strömberg ◽  
J. Karlsson ◽  
J. Fridén
Keyword(s):  
Joint Instability ◽  
Clinical Signs ◽  
Case Series ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Arthroscopy ◽  
Level Of Evidence ◽  
Independent Observer ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage

A total of 20 patients scheduled for wrist arthroscopy, all with clinical signs of rupture to the triangular fibrocartilage complex and distal radioulnar joint instability, were tested pre-operatively by an independent observer for strength of forearm rotation. During surgery, the intra-articular pathology was documented by photography and also subsequently individually analysed by another independent hand surgeon. Arthroscopy revealed a type 1-B injury to the triangular fibrocartilage complex in 18 of 20 patients. Inter-rater reliability between the operating surgeon and the independent reviewer showed absolute agreement in all but one patient (95%) in terms of the injury to the triangular fibrocartilage complex and its classification. The average pre-operative torque strength was 71% of the strength of the non-injured contralateral side in pronation and supination. Distal radioulnar joint instability with an arthroscopically verified injury to the triangular fibrocartilage complex is associated with a significant loss of both pronation and supination torque. Level of evidence: Case series, Level IV.

Radioulnar Ratio in Detection of Distal Radioulnar Joint Instability Associated With Acute Distal Radius Fractures

2010 ◽  
Vol 35 (9) ◽  
pp. 730-734 ◽  
Author(s):  
J.H. Scheer ◽  
S. Hammerby ◽  
L.E. Adolfsson
Keyword(s):  
Computed Tomography ◽  
Prospective Study ◽  
Distal Radius ◽  
Joint Instability ◽  
Stress Test ◽  
Distal Radioulnar Joint ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage

Lesions of the triangular fibrocartilage complex (TFCC) are commonly associated with distal radius fractures and may adversely affect the functional outcome. This prospective study evaluated computed tomography, using the radioulnar ratio (RUR), to detect laxity of the distal radioulnar joint in 48 consecutive patients with acute distal radius fractures and compared the results with a radioulnar stress test. We found the clinical stress test to be reliable in chronic cases, but the RUR method of questionable value in both acute and chronic cases.

Palmar reconstruction of the triangular fibrocartilage complex for instability of the distal radioulnar joint: a biomechanical study

2012 ◽  
Vol 38 (5) ◽  
pp. 515-522 ◽  
Author(s):  
T. Kataoka ◽  
H. Moritomo ◽  
S. Omokawa ◽  
A. Iida ◽  
T. Wada ◽  
...  
Keyword(s):  
Joint Instability ◽  
Distal Radioulnar Joint ◽  
Biomechanical Study ◽  
Bone Tunnel ◽  
Triangular Fibrocartilage Complex ◽  
Reconstruction Technique ◽  
Radioulnar Joint ◽  
Fresh Cadaver ◽  
Palmar Approach ◽  
Triangular Fibrocartilage

We developed a new triangular fibrocartilage complex reconstruction technique for distal radioulnar joint instability in which the palmar portion of the triangular fibrocartilage complex was predominantly reconstructed, and evaluated whether such reconstruction can restore stability of the distal radioulnar joint in seven fresh cadaver upper extremities. Distal radioulnar joint instability was induced by cutting all soft-tissue stabilizers around the distal ulna. Using a palmar approach, a palmaris longus tendon graft was sutured to the remnant of the palmar radioulnar and ulnocarpal ligaments. The graft was then passed through a bone tunnel created at the fovea and was sutured. Loads were applied to the radius, and dorsopalmar displacements of the radius relative to the ulna were measured using an electromagnetic tracking device in neutral rotation, 60° supination and 60° pronation. We compared the dorsopalmar displacements before sectioning, before reconstruction and after reconstruction. Dorsopalmar instability produced by sectioning significantly improved in all forearm positions after reconstruction.

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