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.

The rein-type arthroscopic capsular suture for triangular fibrocartilage complex foveal tears: midterm results for 90 patients

2021 ◽  
pp. 175319342110241
Author(s):  
I-Ning Lo ◽  
Kuan-Jung Chen ◽  
Tung-Fu Huang ◽  
Yi-Chao Huang
Keyword(s):  
Simple Procedure ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Joint Stability ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
High Satisfaction ◽  
Ultrasound Assessment ◽  
Triangular Fibrocartilage

We describe an arthroscopic rein-type capsular suture that approximates the triangular fibrocartilage complex to the anatomical footprint, and report the results at a minimum 12 month follow-up. The procedure involves two 3-0 polydioxanone horizontal mattress sutures inserted 1.5 cm proximal to the 6-R and 6-U portals to obtain purchase on the dorsal and anterior radioulnar ligaments, respectively. The two sutures work as a rein to approximate the triangular fibrocartilage complex to the fovea. Ninety patients with Type IB triangular fibrocartilage complex injuries were included retrospectively. The 12-month postoperative Modified Mayo Wrist scores, Disabilities of Arm, Shoulder and Hand scores and visual analogue scale for pain showed significant improvements on preoperative values. Postoperative range of wrist motion, grip strength and ultrasound assessment of the distal radioulnar joint stability were comparable with the normal wrist. The patients had high satisfaction scores for surgery. There were minor complications of knot irritation. No revision surgery for distal radioulnar joint instability was required. It is an effective and technically simple procedure that provides a foveal footprint contact for the triangular fibrocartilage complex. Level of evidence: IV

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.

TREATMENTS OF OSTEOARTHRITIS OF THE DISTAL RADIOULNAR JOINT: LONG-TERM RESULTS OF THREE PROCEDURES

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 243-248 ◽  
Author(s):  
Akio Minami ◽  
Norimasa Iwasaki ◽  
Jun-ichi Ishikawa ◽  
Naoki Suenaga ◽  
Kazunori Yasuda ◽  
...  
Keyword(s):  
Grip Strength ◽  
Statistical Significance ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Ulnar Variance ◽  
Long Term Results ◽  
Interposition Arthroplasty ◽  
Secondary Osteoarthritis ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage

Sixty-one wrists in 61 patients with osteoarthritis of the distal radioulnar joint treated by three consecutive procedures (20 Darrach, 25 Sauvé-Kapandji and 16 hemiresection-interposition arthroplastic procedures) were retrospectively evaluated. We preferred to perform Darrach's procedure in even the early stages of osteoarthritis of the distal radioulnar joint prior to introduction of Sauvé-Kapandji and hemirestion-interposition arthroplastic procedures. Subsequently the hemirestion-interposition arthroplasty was indicated when the triangular fibrocartilage cartilage was intact or could be reconstructed and the Sauvé-Kapandji when the triangular fibrocartilage complex could not be reconstructed or there was positive ulnar variance of more than 5 mm even though the triangular fibrocartilage complex was functional. Patient's age at operation averaged 59.8 years. There were 36 men and 25 women. There were 38 primary and 23 secondary osteoarthritis cases. Post-operative pain, range of motion, grip strength, return to work status; and radiographic results were evaluated. At the five- to 14-year (average, ten years) follow-up evaluation, relief of pain from Darrach procedure was inferior to the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty although this was not statistically significant. After both the Sauvé-Kapandji procedure and hemiresection-inteposition arthroplasty, post-operative improvements in flexion and extension of the wrist had statistical significance. Post-operative improvements in pronation and supination of the forearm showed statistical significances after all procedures. Improvements of post-operative grip strength and return to an original job in the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty were statistically superior to those with a Darrach's procedure. There were many post-operative complications following the Darrach's procedure. Darrach's procedure is better indicated for severe osteoarthritic changes of the distal radioulnar joint in elderly patients. We believe the operative indications between the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty are best determined prior to surgery by the existence and status of the triangular fibrocartilage complex and the amount of the positive ulnar variance.

scholarly journals The Optimal Suture Placement and Bone Tunnels for TFCC Repair: A Cadaveric Study

2018 ◽  
Vol 07 (05) ◽  
pp. 375-381 ◽  
Author(s):  
Peter Tang ◽  
Keiji Fujio ◽  
Robert Strauch ◽  
Melvin Rosenwasser ◽  
Taiichi Matsumoto
Keyword(s):  
Distal Radioulnar Joint ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Transosseous Repair ◽  
Triangular Fibrocartilage ◽  
The Mean ◽  
Group 5 ◽  
Bone Tunnels ◽  
Isometric Point ◽  
Suture Placement

Background Transosseous repair of foveal detachment of the triangular fibrocartilage complex (TFCC) is effective for distal radioulnar joint stabilization. However, studies of the optimal foveal and TFCC suture positions are scant. Purpose The purpose of this study was to clarify the optimal TFCC suture position and bone tunnels for transosseous foveal repair. Materials and Methods Seven cadavers were utilized. The TFCC was incised at the foveal insertion and sutured at six locations (TFCCs 1–6) using inelastic sutures. Six osseous tunnels were created in the fovea (foveae 1–6). Fovea 2 is located at the center of the circle formed by the ulnar head overlooking the distal end of the ulna (theoretical center of rotation); fovea 5 is located 2 mm ulnar to fovea 2. TFCC 5 is at the ulnar apex of the TFCC disc; TFCC 4 is 2 mm dorsal to TFCC 5. TFCC 1 to 6 sutures were then placed through each of the six osseous tunnels, resulting in 36 combinations, which were individually tested. The forearm was placed in five positions between supination and pronation, and the degree of suture displacement was measured. The position with the least displacement indicated the isometric point of the TFCC and fovea. Results The mean distance of suture displacement was 2.4 ± 1.6 mm. Fovea 2, combined with any TFCC location, (0.7 ± 0.6 mm) and fovea group 5, combined with TFCC 4 location (0.8 ± 0.8) or with TFCC 5 location (0.9 ± 0.6) had statistically shorter suture displacements than any other fovea groups. Conclusion For TFCC transosseous repair, osseous tunnel position was more important than TFCC suture location.

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.

scholarly journals Anatomic Reconstruction of the Triangular Fibrocartilage Complex for the Treatment of Chronic Instability of the Distal Radioulnar Joint. A Systematic Review

2021 ◽  
Vol 49 (02) ◽  
pp. e97-e104
Author(s):  
Ignacio Miranda ◽  
Francisco J. Lucas ◽  
Vicente Carratalá ◽  
Joan Ferràs-Tarragó ◽  
Francisco J. Miranda
Keyword(s):  
Systematic Review ◽  
Surgical Techniques ◽  
Case Series ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Anatomic Reconstruction ◽  
Wrist Arthroscopy ◽  
Radioulnar Joint ◽  
Druj Instability ◽  
Triangular Fibrocartilage

Abstract Introduction Peripheral injuries of the triangular fibrocartilage complex (TFCC) can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the reconstruction of the TFCC. The aim of the present paper was to summarize the tendon plasties of the DRUJ ligaments for the anatomic reconstruction of TFCC, to analyze the surgical techniques, and to evaluate their outcomes. Methods In order to perform a systematic review, we searched in the literature the terms DRUJ instability OR chronic distal radioulnar joint instability OR distal radioulnar tendon plasty. Results In total, 11 articles with level of evidence IV (case series) were retrieved. Most studies achieved good results, with recovery of wrist stability, improvement of the pain, and increase in grip strength in the functionality tests. In the historical evolution of the published series, wrist surgeons tried to perform a more anatomical plasty, with a more stable fixation and less invasive techniques. Conclusion The Adams procedure continues to be a valid and reproducible technique for the treatment of chronic DRUJ instability. If wrist arthroscopy and implants are available and surgeons have been technically trained, the authors recommend an arthroscopy-assisted technique, or, if possible, an all-arthroscopic TFCC reconstruction with implant fixation of the plasty in its anatomical points of insertion. Comparative studies between open and arthroscopic TFCC reconstruction techniques are needed.

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