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HO JW, Kim JY, Lee YK. Acute blockage of forearm supination due to flap tear of the triangular fibrocartilage disc: A case report. Medicine (Baltimore) 2024; 103:e37915. [PMID: 38640286 PMCID: PMC11029995 DOI: 10.1097/md.0000000000037915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/26/2024] [Indexed: 04/21/2024] Open
Abstract
RATIONALE Acute blockage of forearm supination has been reported in several studies. It is caused by loose bodies in the wrist joint, extensor carpi ulnaris tendon interposition, and distal radioulnar joint (DRUJ) injuries, including forearm bone fractures. Some studies have reported cases of DRUJ injuries caused by triangular fibrocartilage complex (TFCC) tears.We report a case of acute blockage of forearm supination after minor trauma and suggest a possible TFCC tear when a patient complains of forearm supination blocking. In addition, we present a comparison between our case and other reports on etiology, magnetic resonance imaging (MRI) findings, and arthroscopic findings, and show the specific characteristics of our case. PATIENTS CONCERNS A 22-year-old male presented with left wrist pain as the chief complaint. He was injured 2 months prior to pushing his left hand on the floor during exercise. Physical examination showed a relative limitation of range of motion (ROM) in the left wrist of about 10° in flexion and about 15° in extension compared with the right side. The patient also complained of supination limitation and volar side wrist pain during supination. The patient showed tenderness in the axial compression test. DIAGNOSES Plain radiographs showing no abnormalities. MRI showed a TFCC tear in the central portion. A torn flap of the TFCC was interposed on the volar side of the DRUJ. INTERVENTIONS Arthroscopic surgery of the left wrist joint was performed. Arthroscopic examination revealed a tear in the TFCC on the radial side. A torn flap was interposed on the volar side of the DRUJ. We removed the flap from the DRUJ using an arthroscopic grasper and partially resected it. OUTCOMES Intraoperative tests showed no locking and the forearm was well supinated. Two months after the surgery, the patient had no pain and showed full forearm supination. LESSONS DRUJ blocking due to a TFCC tear should be suspected when acute blockage of forearm supination occurs after minor trauma. MRI is helpful for diagnosis; however, we suggest that the diagnosis should be confirmed through arthroscopy. Symptoms can be resolved by surgical treatment using arthroscopy.
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Affiliation(s)
- Ji Woong HO
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Jee Yune Kim
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Young-Keun Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
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Ecker J, Pavleski K, Andrijich C. The Hook Test Is Not Pathognomonic for Foveal Detachment of the Triangular Fibrocartilage. J Wrist Surg 2024; 13:44-48. [PMID: 38264126 PMCID: PMC10803151 DOI: 10.1055/s-0043-1770077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/09/2023] [Indexed: 01/25/2024]
Abstract
Background The integrity of the foveal insertion of the triangular fibrocartilage complex (TFCC) is currently assessed by inference using the hook test. Using dry arthroscopic techniques, the primary author observed that many patients with painful distal radioulnar joint (DRUJ) instability and a positive hook test had an intact foveal insertion. This study was performed to determine whether a positive hook test is a reliable index of a tear of the foveal insertion. Technique The hook test is performed using a probe to elevate the TFCC off the ulna head toward the articular surface of the lunate. In this study, the hook test was considered positive if the TFCC could be elevated to bridge more than 80% of the space between the TFCC and the articular surface of the lunate. Patients and Methods A retrospective study was performed using the medical records and arthroscopic videos of 113 patients who had clinical signs of DRUJ instability and underwent arthroscopic surgery performed by the primary author in 2020. It was documented whether the hook test was positive or negative, whether the foveal insertion was intact, abnormal or absent, and whether there were peripheral (dorsal or volar) tears of the TFCC. Sensitivity and specificity were calculated using arthroscopic findings as the reference standard. Results The sensitivity of the hook test was found to be 100%, and the specificity was 7.0%. The positive predictive value for foveal pathology was found to be 12.3% and the negative predictive value 100%. The diagnostic accuracy of the hook test in determining the presence of foveal tears was found to be 17.7%. The diagnostic accuracy of the hook test in determining the presence of a TFCC abnormality was 99.1%. Conclusions A positive hook test is indicative of a tear of the TFCC, but it is not anatomically specific for a tear of the foveal insertion. To reliably assess the foveal insertion, it must be visualized and probed using dry arthroscopic techniques.
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Affiliation(s)
- Jeff Ecker
- Jeff Ecker Clinic, Bethesda Hospital, Claremont, Western Australia, Australia
- Wrist + Hand Institute, Claremont, Western Australia, Australia
- Hand and Upper Limb Centre, Claremont, Western Australia, Australia
- Health Sciences Department, Curtin University, Kent Street, Bentley, Western Australia, Australia
- UWA Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Karolina Pavleski
- Jeff Ecker Clinic, Bethesda Hospital, Claremont, Western Australia, Australia
- Wrist + Hand Institute, Claremont, Western Australia, Australia
| | - Courtney Andrijich
- Jeff Ecker Clinic, Bethesda Hospital, Claremont, Western Australia, Australia
- Wrist + Hand Institute, Claremont, Western Australia, Australia
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Abstract
To evaluate triangular fibrocartilage complex (TFCC) injury based on quantitative analysis of fibrocartilage by 3.0T MR 3D VIBE and T2 mapping techniques. In this study, 25 patients with TFCC (15 patients with unilateral injury and 10 patients with bilateral injury) and 30 healthy subjects were enrolled. All 55 participants underwent bilateral wrist joint routine plain scan + enhanced scan, 3D VIBE and T2 mapping sequence scan. The 2 hands were divided into the dominant group and the non-dominant hand group. Pseudo-color images of T2 mapping were obtained through the post-processing workstation. Except for the meniscus homologue, there were statistical differences in the overall mean T2 value of all other regions between the injured group and the healthy group (P < .001). The T2 value of each region in the injury group was statistically different in the pairwise comparison (all P < .02). There was no statistical difference in the overall mean T2 value between the dominant hand group and the non-dominant hand group. 3.0T MR 3D VIBE and T2 mapping techniques are helpful for the evaluation of TFCC injury and the quantitative analysis of fibrocartilage. The parameters can reflect molecular changes of fibrocartilage injury, and T2 values are not affected by dominant hand, age and gender.
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Affiliation(s)
- Mei Yan
- Department of Medical Imaging Center, Qinghai University Affiliated Hospital, Xining, China
| | - Shengbao Wen
- Department of Medical Imaging Center, Qinghai University Affiliated Hospital, Xining, China
- * Correspondence: Shengbao Wen, Department of Medical Imaging Center, Qinghai University Affiliated Hospital, Xining 810001, China (e-mail: )
| | - Xueyan Wang
- Department of Medical Imaging Center, Qinghai University Affiliated Hospital, Xining, China
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Lu C, Wang P, Zhang L, Dong J, Zhang H, Yang L, Wang X, Xiong H. Clinical Study of Wrist Arthroscopy Combined with Oblique Ulnar Shortening Osteotomy in the Treatment of Ulnar Impaction Syndrome. Orthop Surg 2022; 14:2947-2954. [PMID: 36178102 PMCID: PMC9627053 DOI: 10.1111/os.13428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To explore the clinical effects of wrist arthroscopy combined with oblique ulnar shortening osteotomy in the treatment of ulnar impaction syndrome. Methods This was a retrospective study of 60 patients with ulnar impaction syndrome who were admitted to our department from January 2016 to December 2019. According to different surgical methods, they were divided into an observation group and a control group, with 30 cases in each group. The control group was treated with oblique ulnar shortening osteotomy, and the observation group used wrist arthroscopy based on the control group. The two groups of patients were compared in terms of wrist function before and 12 months after surgery. We compared the Disabilities of the Arm, Shoulder, and Hand Score (DASH Score), Patient‐Rated Wrist Evaluation Score (PRWE Score), Visual Analog Score (VAS), and ulnar variation between the two groups at 12 months after surgery. The excellent and good rates by Mayo wrist score were compared between the two groups at the last follow‐up. Results All patients were followed up for 12–36 months, with an average of 14.5 months. Bone union was achieved at the oblique osteotomy of the ulna, with an average healing time of 13.6 weeks. The observation group was examined by wrist arthroscopy, and the triangular fibrocartilage complex (TFCC) Palmer classification was confirmed in three cases of type IIA, seven cases of type IIB, 14 cases of type IIC, and six cases of type IID. Compared with before surgery, the grip strength, flexion‐extension, ulnar radial deflection, and forearm rotation of the two groups of patients were significantly improved at 12 months after surgery. The DASH score, PRWE score, and VAS score of the observation group were better than those of the control group, and the difference in ulnar shortening length was not statistically significant between the two groups. The excellent and good rates of the observation group (93.3%) were better than those of the control group (87.5%) at the last follow‐up, and the difference was statistically significant. Conclusion Compared with oblique ulnar shortening osteotomy alone, combined wrist arthroscopy can better reduce the pain of patients with ulnar impaction syndrome, restore wrist function, and improve the excellent and good rates. Therefore, it is clinically worthy of promotion.
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Affiliation(s)
- Chengyin Lu
- Department of Graduate School, Hunan University of Chinese Medicine, Changsha, China.,Department of Sports Medicine, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang, China
| | - Pengtao Wang
- Department of Graduate School, Henan University of Chinese Medicine, Zhengzhou, China
| | - Laifu Zhang
- Department of Sports Medicine, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang, China
| | - Jiahe Dong
- Department of Graduate School, Henan University of Chinese Medicine, Zhengzhou, China
| | - Hailong Zhang
- Department of Sports Medicine, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang, China
| | - Lei Yang
- Department of Graduate School, Hunan University of Chinese Medicine, Changsha, China
| | - Xiaohui Wang
- Department of Sports Medicine, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang, China
| | - Hui Xiong
- Department of Graduate School, Hunan University of Chinese Medicine, Changsha, China
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Abstract
Background Arthroscopy of the distal radioulnar joint is considered to be difficult to perform. At this time the integrity of the foveal insertion is indirectly evaluated with a hook test. If a hook test is positive it is inferred that the foveal insertion is torn or incompetent. Description of Technique The ideal way to evaluate the foveal insertion is by direct visualization and probing. In order to do this, arthroscopic examination of the distal radioulnar joint and foveal insertion is required. The article describes how to reliably perform "dry" arthroscopy of the distal radioulnar joint and foveal insertion using a 1.9 mm arthroscope to accurately assess the triangular fibrocartilage complex and foveal insertion. Patient and Methods A total of 169 dry DRUJ arthroscopies were performed by the primary author between January 2018 and February 2021. Results Using this technique, the foveal insertion was successfully visualized in 168 cases (99%). Conclusion Dry arthroscopy of the DRUJ is a reliable technique to evaluate the integrity of the foveal insertion.
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Affiliation(s)
- Jeff Ecker
- Jeff Ecker Clinic, Bethesda Hospital, Claremont, Western Australia, Australia
- Hand and Upper Limb Centre, Claremont, Western Australia, Australia
| | - Courtney Andrijich
- Jeff Ecker Clinic, Bethesda Hospital, Claremont, Western Australia, Australia
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6
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Abstract
Aims Studies on long-term patient-reported outcomes after open surgery for triangular fibrocartilage complex (TFCC) are scarce. Surgeons and patients would benefit from self-reported outcome data on pain, function, complications, and satisfaction after this surgery to enhance shared decision-making. The aim of this study is to determine the long-term outcome of adults who had open surgery for the TFCC. Methods A prospective cohort study that included patients with open surgery for the TFCC between December 2011 and September 2015. In September 2020, we sent these patients an additional follow-up questionnaire, including the Patient-Rated Wrist Evaluation (PRWE), to score satisfaction, complications, pain, and function. Results A total of 113 patients were included in the analysis. At ≥ 60 months after an open TFCC reinsertion, we found a mean PRWE total score of 19 (SD 21), a mean PRWE pain score of 11 (SD 11), and a PRWE function score of 9 (SD 10). The percentage of patients obtaining minimum clinically important difference rose from 77% at 12 months to 83% at more than 60 months (p < 0.001). Patients reported fewer complications than surgeons, and overall complication rate was low. Conclusion Outcomes of patient-reported pain, function scores, and satisfaction are improved five years after open surgery for the TFCC. Cite this article: Bone Jt Open 2021;2(11):981–987.
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Affiliation(s)
- Reinier Feitz
- Hand Surgery, Xpert Clinics, Amsterdam, Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Sara Khoshnaw
- Hand Surgery, Xpert Clinics, Amsterdam, Netherlands.,Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Mark J W van der Oest
- Hand Surgery, Xpert Clinics, Amsterdam, Netherlands.,Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Harm P Slijper
- Hand Surgery, Xpert Clinics, Amsterdam, Netherlands.,Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Steven E R Hovius
- Hand Surgery, Xpert Clinics, Amsterdam, Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, Netherlands
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Ou Yang O, McCombe DB, Keating C, Maloney PP, Berger AC, Tham SKY. Ulnar-sided wrist pain: a prospective analysis of diagnostic clinical tests. ANZ J Surg 2021; 91:2159-2162. [PMID: 34459533 DOI: 10.1111/ans.17169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/15/2021] [Accepted: 07/23/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Identifying the cause of pain on the ulnar side of the wrist can be challenging. The outcome and recovery following surgery can be unpredictable. The aim of this study was to document and analyse the clinical tests used to evaluate the cause of ulnar-sided wrist pain and determine their diagnostic relevance. METHODS This is a prospective evaluation of 110 patients who presented with pain on the ulnar side of the wrist. The clinical evaluation and results from radiological investigations were documented and analysed. RESULTS There were 17 different diagnoses. Eighty-five percent of the diagnoses were triangular fibrocartilage complex (TFCC) injuries, ulnocarpal abutment syndrome (UCAS), pisotriquetral arthritis (PTA), triquetral fracture or non-union, distal radioulnar joint arthritis (DRUJ OA) and extensor carpi ulnaris (ECU) pathology. The ulnocarpal stress test and ulnar foveal sign were positive in several diagnoses. The ulnar foveal sign had a sensitivity and specificity of 89% and 48% for TFCC injuries, and 85% and 37% for UCAS, respectively. The sensitivity and specificity of pisotriquetral shear test for PTA was 100% and 92%, respectively. Patients with PTA or ECU pathology localised their pain better on the patient's pain localisation chart. CONCLUSION Diagnosis of TFCC injuries, UCAS, DRUJ OA and ECU injuries are challenging as the clinical symptoms and signs for the four diagnoses were similar and required either magnetic resonance imaging or computed tomography for diagnostic confirmation after clinical examination. The ulnocarpal stress test and the ulnar foveal sign were not sufficiently specific.
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Affiliation(s)
- Owen Ou Yang
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia.,Department of Plastic and Hand Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - David B McCombe
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia.,Department of Plastic and Hand Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia.,Hand and Wrist Biomechanics Laboratory, O'Brien Institute/St Vincent's Institute, Fitzroy, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Flemington, Victoria, Australia
| | - Cameron Keating
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
| | - Peter P Maloney
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia.,Department of Plastic and Hand Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Anthony C Berger
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia.,Department of Plastic and Hand Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Stephen K Y Tham
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia.,Department of Plastic and Hand Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia.,Hand and Wrist Biomechanics Laboratory, O'Brien Institute/St Vincent's Institute, Fitzroy, Victoria, Australia
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8
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Namazi H, Ghane A, Dehghanian AR, Fereidooni M, Akbarzadeh A. Effectiveness and Safety of Triangular Fibrocartilage Complex Injection Regarding Anatomical Landmarks: A Cadaveric Study. J Wrist Surg 2021; 10:286-289. [PMID: 34381630 PMCID: PMC8328542 DOI: 10.1055/s-0041-1723795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Background Triangular fibrocartilage complex (TFCC) injections can be applied using anatomical landmarks or under the guide of ultrasound (US). US is not always available, and the physician may rely on the anatomical landmarks. Objective The study aims to evaluate the effectiveness and safety of TFCC injection with anatomic landmarks. Methods Forty wrist specimens from cadavers were randomly assigned to four rapid blue stain injection groups as follows: Group A: perpendicular to skin with 5 mm depth; Group B: perpendicular to skin with 10 mm depth; Group C: 45-degree angulation to skin surface, oriented from proximal to distal with 10 mm depth; and Group D: 45-degree angulation to skin surface, oriented from distal to proximal with 10 mm depth. TFCC specimens were excised and evaluated with microscopy, and adjacent neurovascular structures were checked for any injury. Results Injections in group A were more accurate than others, in which 8/10 injections were successful. Group C injections were least accurate in that only 4/10 were successful. The other remaining groups (groups B and D) revealed similar results (5/10 were successful). However, statistical analyses did not show any significant difference ( p -value = 0.35). No injury to neurovascular structures was seen. Conclusion Needle placement perpendicular to skin with 5 mm depth and just medial to ulnar styloid can be used as an accurate method of palpation-guided technique for TFCC injections.
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Affiliation(s)
- Hamid Namazi
- Department of Orthopedic Surgery, Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Ghane
- Department of Orthopedic Surgery, Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Reza Dehghanian
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Fereidooni
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Armin Akbarzadeh
- Department of Orthopedic Surgery, Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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9
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Abstract
Objective This study systematically reviews the outcomes of surgical repair of triangular fibrocartilage complex (TFCC) tears. Existing surgical techniques include capsular sutures, suture anchors, and transosseous sutures. However, there is still no consensus as to which is the most reliable method for ulnar-sided peripheral and foveal TFCC tears. Methods A systematic review of MEDLINE and EMBASE was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The focus was on traumatic Palmer 1B ulna-sided tears. Twenty-seven studies were included, including three comparative cohort studies. Results There was improvement in all functional outcome measures after repair of TFCC tears. The outcomes following peripheral and foveal repairs were good overall: Mayo Modified Wrist Evaluation (MMWE) score of 80.1 and 85.1, Disabilities of the Arm, Shoulder and Hand (DASH) score of 15.7 and 15.8, grip strength of 80.3 and 92.7% (of the nonoperated hand), and pain intensity score of 2.1 and 1.7, respectively. For peripheral tears, transosseous suture technique achieved better outcomes compared with capsular sutures in terms of grip strength, pain, Patient-Rated Wrist Evaluation (PRWE), and DASH scores (grip 85.8 vs. 77.7%; pain 1.5 vs. 2.2; PRWE 11.6 vs. 15.8; DASH 14.4 vs. 16.1). For foveal tears, transosseous sutures achieved overall better functional outcomes compared with suture anchors (MMWE 85.4 vs. 84.9, DASH 10.9 vs. 20.6, pain score 1.3 vs. 2.1), but did report slightly lower grip strength than the group with suture anchors (90.2 vs. 96.2%). Arthroscopic techniques achieved overall better outcomes compared with open repair technique. Conclusion Current evidence demonstrates that TFCC repair achieves good clinical outcomes, with low complication rates. Level of Evidence This is a Level IV, therapeutic study.
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Affiliation(s)
- Edward H. Liu
- Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
| | - Kary Suen
- Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
| | - Stephen K. Tham
- Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
- Victorian Hand Surgery Associates, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Monash Medical Centre, Melbourne, Victoria, Australia
- Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute Fitzroy, Melbourne, Victoria, Australia
| | - Eugene T. Ek
- Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Monash Medical Centre, Melbourne, Victoria, Australia
- Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute Fitzroy, Melbourne, Victoria, Australia
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
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10
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Löw S, Herold A, Unglaub F, Megerle K, Erne H. Treatment of Ulnar Impaction Syndrome with and without Central TFC Lesion. J Wrist Surg 2018; 7:133-140. [PMID: 29576919 PMCID: PMC5864492 DOI: 10.1055/s-0037-1607073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Steffen Löw
- Section of Hand Surgery, Department of Orthopaedic and Trauma Surgery, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Alexandra Herold
- Section of Hand Surgery, Department of Orthopaedic and Trauma Surgery, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Frank Unglaub
- Department of Hand Surgery, Vulpius Clinic, Bad Rappenau, Germany
| | - Kai Megerle
- Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Holger Erne
- Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
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11
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Abstract
UNLABELLED The classical definition of 'Palmer Type IB' triangular fibrocartilage complex tear, includes a spectrum of clinical conditions. This review highlights the clinical and arthroscopic criteria that enable us to categorize five classes on a treatment-oriented classification system of triangular fibrocartilage complex peripheral tears. Class 1 lesions represent isolated tears of the distal triangular fibrocartilage complex without distal radio-ulnar joint instability and are amenable to arthroscopic suture. Class 2 tears include rupture of both the distal triangular fibrocartilage complex and proximal attachments of the triangular fibrocartilage complex to the fovea. Class 3 tears constitute isolated ruptures of the proximal attachment of the triangular fibrocartilage complex to the fovea; they are not visible at radio-carpal arthroscopy. Both Class 2 and Class 3 tears are diagnosed with a positive hook test and are typically associated with distal radio-ulnar joint instability. If required, treatment is through reattachment of the distal radio-ulnar ligament insertions to the fovea. Class 4 lesions are irreparable tears due to the size of the defect or to poor tissue quality and, if required, treatment is through distal radio-ulnar ligament reconstruction with tendon graft. Class 5 tears are associated with distal radio-ulnar joint arthritis and can only be treated with salvage procedures. This subdivision of type IB triangular fibrocartilage complex tear provides more insights in the pathomechanics and treatment strategies. LEVEL OF EVIDENCE II.
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Affiliation(s)
- A Atzei
- 1 Fenice Hand Surgery, Policlinico "San Giorgio", Pordenone, Italy.,2 Hand Surgery Unit, Casa di Cura 'Giovanni XXIII', Treviso, Italy
| | - R Luchetti
- 3 Rimini Hand Surgery and Rehabilitation Center, Rimini, Italy
| | - L Garagnani
- 4 Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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12
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Huang HK, Wang JP, Wang ST, Huang YC, Liu CL. Freehand technique with the predrilled hole method for ulnar-shortening osteotomy. J Chin Med Assoc 2016; 79:77-82. [PMID: 26360243 DOI: 10.1016/j.jcma.2015.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Ulnar shortening is a common and useful method for treating ulnar wrist pain from many causes. Many devices used to perform osteotomy have been introduced in the literature; however, the devices are not universally available. The standard freehand technique is still commonly used in clinical practice; however, it is associated with several complications and is time-consuming. We present a freehand technique for ulnar-shortening osteotomy using a predrilled hole method. METHODS From 2011 to 2013, we performed the predrilled hole method for ulnar shortening in 18 cases using the six-hole limited-contact dynamic compression plate (LC-DCP) and in two cases using the Acumed six-hole Locking Midshaft Ulna Plate. RESULTS All patients had uneventful union, and the average operative time was 39.7 minutes (range, 32-50 minutes). The average follow-up period was 21 months (range, 12-30 months). There were no complications except in three patients in the LC-DCP group who complained of implant irritation. Good functional outcomes were achieved with this method. CONCLUSION Our technique is easy and quick to use and can minimize soft-tissue manipulation. The union rate is high and complications are few.
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Affiliation(s)
- Hui-Kuang Huang
- Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Orthopedics, Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC; Chung Hwa University of Medical Technology, Tainan, Taiwan, ROC
| | - Jung-Pan Wang
- Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
| | - Shih-Tien Wang
- Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Chao Huang
- Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chien-Lin Liu
- Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Abstract
Arthrodesis is the most reliable and durable surgical procedure for the treatment of a joint disorder, and its only disadvantage is the loss of motion of the fused joint. The distal radioulnar joint can be arthrodesed, while forearm pronation and supination are maintained or even improved by creating a pseudoarthrosis of the ulna just proximal to the arthrodesis. This is known as the Sauvé-Kapandji (S-K) procedure. The Sauvé-Kapandji differs from the Darrach procedure in that it preserves ulnar support of the wrist, as the distal radioulnar ligaments and ulnocarpal ligaments are maintained. Aesthetic appearance is also superior after the S-K procedure, as the normal prominence of the ulnar head, most noticeable when the forearm is in pronation, is maintained. However, the S-K is not free of possible complications, such as nonunion or delayed union of the arthrodesis, fibrous or osseous union at the pseudoarthrosis, and painful instability at the proximal ulna stump. All of these complications can be prevented if a careful surgical technique is used.
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Affiliation(s)
- Alberto Lluch
- Institut Kaplan for Surgery of the Hand and Upper Extremity, Barcelona, Spain
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