OBJECTIVE: To investigate the effectivess of arthroscopic Wafer surgery combined with triangular fibrocartilage complex (TFCC) insertion point reconstruction in the treatment of Palmer type ⅡC combined with typeⅠB ulnar impingement syndrome. METHODS: The clinical data of 14 patients with Parlmer type ⅡC combined with type ⅠB ulnar impingement syndrome who met the selection criteria between July 2021 and April 2024 were retrospectively analyzed. There were 7 males and 7 females with an average age of 43 years ranging from 16 to 59 years. The causes of injury were fall in 8 cases and sprain in 6 cases. The time from injury to operation ranged from 1 to 6 months, with an average of 2.3 months. Distal radioulnar joint instability was found in all cases. Arthroscopic Wafer surgery combined with TFCC insertion point reconstruction was used. The effectiveness was evaluated by comparing the wrist flexion-dorsiflexion range of motion, wrist ulnar deviation-radial deflection range of motion, forearm pronation-supination range of motion, visual analogue scale (VAS) score, and modified Mayo wrist score before and after operation. RESULTS: All patients were followed up 6-12 months, with an average of 9.1 months. The positive variation of ulna was (3.2±0.7) mm before operation, and the negative variation of ulna was (2.2±0.6) mm after operation. There was a significant difference in ulna variation between pre- and post-operation ( t=23.851, P<0.001). The pain symptoms and forearm rotation function of the patients after operation significantly improved. At last follow-up, the wrist flexion-dorsiflexion range of motion, wrist ulnar deviation-radial deflection range of motion, forearm pronation-supination range of motion, VAS score, and modified Mayo wrist score significantly improved when compared with those before operation ( P<0.05). CONCLUSION Arthroscopic Wafer surgery combined with TFCC insertion point reconstruction can effectively relieve wrist pain, enhance the stability of the distal radioulnar joint, and restore the function of the wrist in patients with Palmer type ⅡC combined with type ⅠB ulnar impingement syndrome.
Humans ; Male ; Adult ; Arthroscopy/methods* ; Female ; Triangular Fibrocartilage/surgery* ; Middle Aged ; Range of Motion, Articular ; Retrospective Studies ; Wrist Joint/physiopathology* ; Adolescent ; Young Adult ; Ulna/surgery* ; Treatment Outcome ; Wrist Injuries/surgery* ; Plastic Surgery Procedures/methods* ; Joint Instability/surgery*

OBJECTIVE: To investigate the effectiveness of three-dimentional (3D) printed personalized guide plate-assisted wrist arthroscopic repair for Palmer type ⅠB triangular fibrocartilage complex (TFCC) injury. METHODS: A retrospective analysis was conducted on the clinical data of 20 patients with Palmer type ⅠB TFCC injuries admitted between January 2023 and March 2024 who met the selection criteria. Among them, 13 were male and 7 were female; ages ranged from 23 to 35 years, with a mean age of 30.3 years. All patients had a history of trauma, 12 cases involved falls and 8 cases involved sprains. All patients demonstrated a positive "piano key sign". MRI revealed deep ulnar-side tears of the TFCC. Conservative treatment for 6 weeks yielded poor or no clinical improvement. The interval from injury to surgery ranged from 2 to 9 months, with a mean of 5.0 months. Patients underwent wrist arthroscopic repair assisted by 3D printed personalized guide plate. Functional recovery was assessed preoperatively and postoperatively using the visual analogue scale (VAS) score for pain, modified Mayo wrist score, and range of motion (ROM) measurements for wrist flexion-extension, ulnar-radial deviation, and pronation-supination. At last follow-up, MRI was performed to evaluate the healing of TFCC. RESULTS: All 20 patients underwent successful surgery without complications such as vascular or nerve injury, fracture, incisional infection, or joint stiffness. All patients were followed up 9-18 months (mean, 12.4 months). At last follow-up, patients demonstrated significant improvements in VAS scores, modified Mayo wrist scores, wrist flexion-extension ROM, ulnar-radial deviation ROM, and pronation-supination ROM compared to preoperative levels ( P<0.05). MRI at last follow-up showed preserved TFCC continuity, excellent healing, and secure fixation. CONCLUSION 3D-printed personalized guide plate significantly improve outcomes in wrist arthroscopic TFCC repair for Palmer type ⅠB injuries. They enable high-quality suturing, facilitate anatomical reconstruction, and markedly enhance wrist function.
Humans ; Arthroscopy/methods* ; Male ; Adult ; Triangular Fibrocartilage/diagnostic imaging* ; Female ; Retrospective Studies ; Printing, Three-Dimensional ; Wrist Injuries/diagnostic imaging* ; Young Adult ; Bone Plates ; Treatment Outcome ; Wrist Joint/surgery* ; Magnetic Resonance Imaging ; Range of Motion, Articular

OBJECTIVE: To explore clinical effect of arthroscopic modification of triangular fibrocartilage complex (TFCC) combined with oblique osteotomy shortening of distal ulna in treating ulna impact syndrome. METHODS: A retrospective analysis was performed on 49 patients with ulnar impingement syndrome admitted from 2017 to 2021, 3 patients were lost to follow-up, and 46 patients were finally included in study, including 23 males and 23 females, aged from 21 to 53 years old with an average of (36.5±3.3) years old. The patients were divided into TFCC group and control group according to different operation methods. Twenty-four patients in TFCC group, including 13 males and 11 females, aged from 21 to 53 years old with an average of (36.5±3.2) years old;10 patients on the left side and 14 patients on the right side;arthroscopic TFCC trimming combined with oblique osteotomy shortening of distal ulna was performed. Twenty-two patients in control group, including 10 males, 12 females, aged from 21 to 53 years old with an average of (36.5±3.3) years old;13 patients on the left side, 9 patients on the right side; oblique osteotomy of distal ulna was performed. Operative time, hospital stay, intraoperative bleeding and osteotomy healing time between two groups were observed and compared. Cooney wrist function score and visual analogue scale (VAS) were used to evaluate improvement of wrist function and pain before and 12 months after operation, respectively. The variation values of ulna and grip strength were compared. RESULTS: The follow-up time of TFCC group ranged from 12 to 21 months with an average of (15.10±2.67) months, and that of control group ranged from 12 to 20 months with an average of (15.06±2.81) months, there was no statistical significance between two groups (P>0.05). Operative time, osteotomy healing time, intraoperative bleeding and hospital stay in TFCC group were (68.51±13.50) min, (16.21±1.16) weeks, (25.13±4.22) ml and (7.35±1.20) d, respectively;while control group were (45.65±5.64) min, (17.46±2.06) weeks, (24.61±5.10) ml and (7.51±1.13) d, respectively; there were statistically significant differences in operative time and osteotomy healing time between two groups (P<0.05). There were no significant differences in intraoperative bleeding and hospital stay between two groups(P>0.05). There were no significant differences in total score and scores of Cooney wrist joint function between two groups before operation(P>0.05). Pain, functional status, range of motion, grip strength and Cooney wrist function score in TFCC group were higher than those in control group at 12 months after operation (P<0.05). According to Cooney wrist joint function score at 12 months after operation, 16 patients got excellent results, 6 good, and 2 fair in TFCC group; while 7 excellent, 11 good and 4 fair in control group;there was no significant difference between two groups (P>0.05). However, the proportion of wrist function recovery in TFCC group was higher than that in control group (P>0.05). At 12 months after operation, VAS of TFCC group (3.41±0.16) was lower than that of control group(3.52±0.13), P<0.005. There was no significant difference in ulnar variation between TFCC group and control group(P>0.05). The grip strength of TFCC group (93.6±10.1) % was better than that of control group (83.5±10.3) % (P<0.005). CONCLUSION Compared with oblique osteotomy shortening of distal ulna, TFCC trimming combined with oblique osteotomy shortening of distal ulna took longer to treat ulna collision syndrome, but the osteotomy healing time was shortened and wrist joint function was improved, especially pain, ulna variation, grip strength and motion were significantly improved.
Humans ; Male ; Female ; Adult ; Triangular Fibrocartilage/surgery* ; Osteotomy/methods* ; Ulna/surgery* ; Middle Aged ; Arthroscopy/methods* ; Retrospective Studies ; Young Adult

PURPOSE: Extensor carpi ulnaris (ECU) subluxation has a low incidence rate, to date, there has only been a few studies evaluating the operative treatment for type of injury. The purpose of this study was to retrospectively analyze 11 patients with ECU subluxation who underwent operative treatment. MATERIALS AND METHODS: Between March 2005 and February 2015, 11 patients received operative treatment. Magnetic resonance imaging and dynamic ultrasound were used to make the diagnosis. ECU subluxation patterns were classified by the Inoue's classification system. There were two cases of type A, one case of type B, five cases of type C, and three cases unfit for Inoue's classification. We also found two cases of radial subluxation and one case of ulnar locked subluxation. In type A and B cases, ECU tendons were relocated then sheaths repair was performed, and the extensor retinaculum reconstruction was performed. In type C cases, the fibro-osseous sheaths were fixed. In the three unclassified cases, extensor retinaculum reconstruction was performed. In all cases, fibro-osseous sheaths were fixed using the anchor suture technique. We compared the clinical results based on the following: motion range of the wrist joint; grip strength; visual analogue scale (VAS) score; quick disabilities of the arm, shoulder and hand (Q-DASH) score; and Mayo wrist score. RESULTS: The median age of patients at the time of the operation was 32 years, and the average follow-up period was 11.2 months. There were five cases of triangular fibrocartilage complex tear, two cases of distal radioulnar joint instability, three cases of ECU split tear as accompanying injury. There were significant differences in the clinical results. The average motion range of the wrist increased compared with the preoperative value (84.7% to 92.4% compared to contralateral normal side). The postoperative VAS score, Q-DASH score and Mayo wrist score showed better results compared with the respective preoperative values (6.0 to 1.1, 40.9 to 12.4, 75.9 to 86.4). CONCLUSION: ECU subluxation is a rare occurrence. Dynamic ultrasound is useful in diagnosing ECU tendon subluxation. Satisfactory results can be obtained with the use of a proper technique, which depends on the type of subluxation.
Arm ; Classification ; Diagnosis ; Dislocations* ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Incidence ; Joint Instability ; Magnetic Resonance Imaging ; Retrospective Studies ; Shoulder ; Suture Techniques ; Tears ; Tendons* ; Triangular Fibrocartilage ; Ultrasonography ; Wrist ; Wrist Joint

BACKGROUNDThe injury of the triangular fibrocartilage complex (TFCC) is a common cause of ulnar-sided wrist pain. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) could demonstrate the detailed complex anatomy of TFCC in Chinese.

METHODSFourteen Chinese cadaveric wrists (from four men and three women; age range at death from 30 to 60 years; mean age at 46 years) and forty healthy Chinese wrists (from 20 healthy volunteers, male/female: 10/10; age range from 21 to 53 years with a mean age of 32 years) in Beijing Jishuitan Hospital from March 2014 to March 2016 were included in this study. All cadavers and volunteers had magnetic resonance (MR) examination of the wrist with coronal T1-weighted and proton density-weighted imaging with fat suppression in three planes, respectively. MR arthrography (MRAr) was performed on one of the cadaveric wrists. Subsequently, all 14 cadaveric wrists were sliced into 2 mm thick slab with band saw (six in coronal plane, four in sagittal plane, and four in axial plane). The MRI features of normal TFCC were analyzed in these specimens and forty healthy wrists.

RESULTSTriangular fibrocartilage, the ulnar collateral ligament, and the meniscal homolog could be best observed on images in coronal plane. The palmar and dorsal radioulnar ligaments were best evaluated in transverse plane. The ulnotriquetral and ulnolunate ligaments were best visualized in sagittal plane. The latter two structures and the volar and dorsal capsules were better demonstrated on MRAr.

CONCLUSIONHigh-resolution 3T MRI is capable to show the detailed complex anatomy of the TFCC and can provide valuable information for the clinical diagnosis in Chinese.

Adult ; Cross-Sectional Studies ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Triangular Fibrocartilage ; anatomy & histology ; diagnostic imaging ; Wrist ; anatomy & histology ; diagnostic imaging ; Wrist Joint ; anatomy & histology ; diagnostic imaging

Ulnar impaction syndrome is one of the common causes of ulnar-sided wrist pain. The pain is usually aggravated by ulnar deviation during a power grip, especially when the forearm is in a pronated position. The most common predisposing factor of ulnar impaction syndrome is ulnar positive variance, which is an increased ulnar length relative to the radius of the radiocarpal joint. However, it can also occur in patients with ulnar neutral or negative variance because ulnar variance can increase during functional activities, including pronation and power gripping. In these patients, the triangular fibrocartilage complex (TFCC) may be thickened. If conservative treatments—lifestyle modification, medication, or wrist splinting—are unsuccessful, surgical treatments, such as wafer procedure or ulnar shortening osteotomy can be considered. The wafer procedure is an effective treatment for ulnar impaction syndrome. It removes the distal 2 to 4 mm of the ulnar head, while preserving the ulnar styloid process from fracturing via a limited open or an arthroscopic approach. The advantages of the wafer procedure are that it does not require bone healing or internal fixation and provides direct access to TFCC. However, it is a technically demanding procedure and is contraindicated in patients with distal radio-ulnar joint (DRUJ) instability, lunotriquetral instability, ulnar minus variance, and with an ulnar positive variance of more than 4 mm. Ulnar shortening osteotomy is the most popular method for the treatment of ulnar impaction syndrome. It can effectively relieve ulnar impaction symptoms and stabilize DRUJ. However, an excessive amount of shortening may increase the peak pressure at DRUJ, which results in DRUJ arthritis. There is also a possibility of delayed union or nonunion in the osteotomy site. To prevent delayed union or nonunion, we should make an effort to decrease the gap in the osteotomy site during surgery. A serial follow-up is also recommended to evaluate the occurrence of arthritis in DRUJ after ulnar shortening.
Arthritis ; Causality ; Follow-Up Studies ; Forearm ; Hand Strength ; Head ; Humans ; Joints ; Methods ; Osteotomy ; Pronation ; Radius ; Triangular Fibrocartilage ; Wrist

The distal radioulnar joint (DRUJ) is a complex structure that enables sufficient, painless forearm rotation and provides weight-bearing capabilities of the upper extremity. Arthritis of DRUJ is multifactorial; the most common causes are trauma, congenital anomalies, as well as degenerative and inflammatory diseases. Congenital etiologies, as well as degenerative and inflammatory causes of arthritis are more common in women. Conventionally, initial management of symptomatic DRUJ arthritis is nonsurgical; surgery is generally reserved for patients with refractory pain. Moreover, advanced arthritis arising from trauma can be prevented by early interventions in the form of corrective osteotomy for malunited distal radius and distal ulna fractures, repair/reconstruction of the triangular fibrocartilage complex, and ulnar shortening osteotomy. Although the outcomes are typically positive following excision of the distal ulna in definitive arthritis, postoperative complications, such as instability and impingement of the residual distal ulna stump, can be serious. Procedures managing unstable residual ulna include soft tissue stabilization techniques and DRUJ implant arthroplasty.
Arthritis* ; Arthroplasty ; Early Intervention (Education) ; Female ; Forearm ; Humans ; Joints* ; Osteotomy ; Pain, Intractable ; Postoperative Complications ; Radius ; Triangular Fibrocartilage ; Ulna ; Ulna Fractures ; Upper Extremity ; Weight-Bearing

Traumatic triangular fibrocartilage complex (TFCC) injuries require multidisciplinary approach and plan. Trauma to TFCC can lead to instability of the distal radioulnar joint (DRUJ). Injury to TFCC is classified as a stable type that does not cause unstable lesions for DRUJ or unstable type that can cause instability of DRUJ. According to the location and severity of the injury, arthroscopic debridement or arthroscopic repair may be considered. In the ulnar side avulsion of TFCC, which could cause DRUJ instability, arthroscopic examination should be performed to identify an accurate location of the damaged structures, followed by arthroscopic debridement and repair. In the event of TFCC and DRUJ injuries with ulnar positive variance, arthroscopic TFCC repair or ulnar shortening osteotomy after arthroscopic debridement could be considered to solve the instability and ulnar side pain. However, if peripheral TFCC tear with ulnar impaction syndrome and DRUJ instability, it combined operation of ulnar shortening osteotomy and TFCC foveal fixation could be considered. An accurate classification of TFCC and DRUJ injuries is necessary. It is important to resolve and prevent recurrence of ulnar wrist pain caused by instability.
Arthroscopy ; Classification ; Debridement ; Joint Instability ; Joints* ; Osteotomy ; Recurrence ; Tears ; Triangular Fibrocartilage* ; Wrist

PURPOSE: There remains uncertain whether to fix or not an ulnar styloid fracture acommpanied by distal radius fracture. Fixation might be required in cases of the fracture involving a fovea of ulnar head, an attachment site of deep triangular fibrocartilage, which is thought to be important to distal radioulnar joint stability. We analyzed a fovea involvement of an accompanied ulnar styloid fracture in patients with distal radius fracture by simple radiograph and three-dimensional computed tomography (3D CT). METHODS: We retrospectively reviewed 168 patients who underwent surgery with volar locking plate for distal radius fracture in our hospital from January 2005 to March 2015 and evaluated a fovea involvement of ulnar head by simple radiographs and 3D CT respectively, and compared. RESULTS: On simple X-ray, 64 cases (38%) were ulnar styloid fovea fractures; however, 21 cases of these revealed non-fovea fractures by 3D CT. And 7 out of 104 cases determined as non-fovea fracture by simple radiographs were diagnosed as fovea fractures by 3D CT. Sensitivity, specificity and accuracy of evaluation by simple radiograph were 86%, 82% and 83% respectively, when compared with those of 3D CT based evaluation. CONCLUSION: Accuracy of evaluating an accompanied ulnar styloid fovea fracture in patients with distal radius fracture by simple radiograph, when compared with 3D CT, was 83%; therefore, we recommend using the 3D CT based evaluation instead of simple radiograph based one for determination of fovea involvement of ulnar head.
Head ; Humans ; Joints ; Radiography* ; Radius Fractures ; Retrospective Studies ; Sensitivity and Specificity ; Triangular Fibrocartilage

The wrist joint is formed by the distal end of the radius and ulna proximally, and eight carpal bones distally. It has many ligaments to maintain stability of the complex bony structures. The incidence of ligament injuries of the wrist has increased due to sports activities. However, diagnosis and management of these injuries are sometimes difficult because of the anatomic complexity and variable injury patterns. Among them, scapholunate ligament injury and triangular fibrocartilage tears are the two most common injuries resulting in chronic disabling wrist pain. Thorough understanding of the wrist anatomy and physical and radiologic examination is mandatory for proper diagnosis and management of these conditions. This article will briefly discuss the wrist joint anatomy and biomechanics, and review the diagnosis and management of the scapholunate ligament injury and triangular fibrocartilage injury.
Carpal Bones ; Diagnosis* ; Incidence ; Ligaments* ; Radius ; Sports ; Tears ; Triangular Fibrocartilage ; Ulna ; Wrist Joint ; Wrist*