Diagnostic value of MRI in traumatic triangular fibrocartilage complex injuries: a retrospective study.

BACKGROUND: Triangular fibrocartilage complex (TFCC) injuries commonly manifest as ulnar-sided wrist pain and can be associated with distal radioulnar joint (DRUJ) instability and subsequent wrist functional decline. This study aimed to assess the diagnostic value of MRI compared to wrist arthroscopy in identifying traumatic TFCC injuries and to determine the distribution of different TFCC injury subtypes in a normal clinical setting. METHODS: The data of 193 patients who underwent both preoperative wrist MRI and wrist arthroscopy were retrospectively reviewed. The analysis focused on the proportion of subtypes and the diagnostic value of MRI in traumatic TFCC injuries, utilizing Palmer's and Atzei's classification with wrist arthroscopy considered as the gold standard. RESULTS: The most prevalent subtype of TFCC injuries were peripheral injuries (Palmer 1B, 67.9%), followed by combined injuries (Palmer 1 A + 1B, 14%; Palmer 1B + 1D, 8.3%). Compared with wrist arthroscopy, the diagnostic sensitivity, specificity, negative predictive value (NPV), and Kappa value of MRI was as follows: traumatic TFCC tears 0.99 (95% CI: 0.97-1), 0.90 (0.78-0.96), 0.97 (0.87-1), and 0.93; styloid lamina tears 0.93 (0.88-0.96), 0.53 (0.30-0.75), 0.47 (0.26-0.69), and 0.44; and foveal lamina tears 0.85 (0.74-0.92), 0.38 (0.29-0.49), 0.79 (0.65-0.89), and 0.21. CONCLUSIONS: The diagnostic value of MRI in traumatic TFCC injuries has been confirmed to be almost perfect using Palmer's classification. In more detailed classification of TFCC injuries, such as pc-TFCC tears classified by Atzei's classification, the diagnostic accuracy of MRI remains lower compared to wrist arthroscopy. Radiological associated injuries may offer additional diagnostic value in cases with diagnostic uncertainty.

Effect of dorsal capsular imbrication on intraoperative DRUJ instability following arthroscopic TFCC repair surgery.

BACKGROUND: To assess the clinical outcomes and identify the ideal indication for implementing dorsal distal radioulnar joint (DRUJ) capsular imbrication after triangular fibrocartilage complex (TFCC) repair in cases of DRUJ instability. METHODS: We conducted a retrospective study on patients who underwent arthroscopic TFCC repair between 2016 and 2021. Inclusion criteria comprised a symptomatic ulna fovea sign for over 6 months and dorsal DRUJ subluxation on magnetic resonance imaging. A total of 225 patients were divided into two groups: Group 1 (135 cases) with a negative ballottement test after "Cross-form TFCC repair" (CR) and Group 2 (90 cases) with a positive ballottement test after "Cross-form TFCC repair" and augmented DRUJ stability through dorsal DRUJ capsular imbrication (CR + DCI). Pain visual analog scale score (VAS), grip strength, modified Mayo Wrist Score (MMWS), wrist range of motion (ROM), and patient-reported outcomes (PROMs) were assessed for a minimum of 3 years postoperatively. RESULTS: Both groups showed significant improvements in pain VAS score, grip strength, wrist ROM, MMWS, and PROMs between the preoperative and postoperative periods (all P < 0.05). Recurrent DRUJ instability occurred in 3.7% and 1.1% of patients in the "CR" and "CR + DCI" groups, respectively, with a significant difference. Despite the "CR + DCI" group initially exhibiting inferior ROM compared with the "CR" group, subsequently, no significant difference was noted between them. CONCLUSIONS: Dorsal DRUJ capsular imbrication effectively reduces postoperative DRUJ instability rates, enhances grip strength, and maintains wrist ROM in patients with a positive intra-operative ballottement test after arthroscopic TFCC repair.

Peripheral tear of the triangular fibrocartilage complex: diagnostic accuracy of magnetic resonance imaging and diagnostic performance of the primary and secondary signs.

OBJECTIVE: This study is to assess the diagnostic performance of magnetic resonance imaging (MRI) findings for type 1B triangular fibrocartilage complex (TFCC) tear of the wrist. MATERIALS AND METHODS: This study retrospectively enrolled 78 patients to examine the diagnostic performance of preoperative MRI examinations in patients with type 1B TFCC tears. Thirty-nine participants had confirmed type 1B TFCC tear. The control group included 39 patients who were randomly selected from 1157 patients who underwent MRI for wrist pain. Both groups underwent a review of 19 MRI findings by two independent radiologists, and the correlation between each diagnostic finding and type 1B TFCC tear was assessed using the chi-squared test. The 19 MRI findings comprised eight primary signs of abnormalities in the distal or proximal lamina, in conjunction with 11 secondary signs suggestive of abnormalities in the surrounding structures. RESULTS: The TFCC tear group demonstrated a significantly higher incidence of two primary MRI signs, i.e., fiber discontinuity and signal alteration in the distal lamina, as observed by both readers (R1, 74.4% vs. 38.5%, p = 0.003, and 87.2% vs. 43.6%, p < 0.001; R2, 74.4% vs. 35.9%, p = 0.001, and 87.2% vs. 53.8%, p < 0.003, respectively). Reader 2 identified a higher prevalence of two additional primary MRI signs: fiber discontinuity and signal alteration in the proximal lamina (all p < 0.05). None of the 11 secondary MRI signs demonstrated statistically significant associations with type 1B TFCC. CONCLUSION: MRI manifestations of fiber discontinuity and signal alteration in the distal lamina may provide predictive markers for type 1B TFCC wrist tear.

Comparing the Outcomes of Suture Anchor Repair and Rein-Type Capsular Suture for Triangular Fibrocartilage Complex Foveal Tears With a Minimum 2-Year Follow-Up.

PURPOSE: Recent biomechanical studies have highlighted the importance of foveal reinsertion when repairing triangular fibrocartilage complex (TFCC) injury with foveal tears. However, clinical studies comparing different repair techniques are scarce. We compared the clinical outcomes of suture anchor repair and rein-type capsular suture in patients with TFCC palmer 1B foveal tears with a minimum of 2-year follow-up. METHODS: This was a single-surgeon, single-center, retrospective, comparative study. We included patients who underwent TFCC repair surgery due to a foveal tear from December 2013 to October 2018 with a minimum follow-up of 24 months. Postoperative Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) score, Modified Mayo Wrist Score, visual analogue scale for pain, wrist range of motion, and grip strength were compared. We also measured the maximal ulnar head displacement with dynamic ultrasound to quantify distal radioulnar joint stability. RESULTS: In total, 103 patients were in the suture anchor group (group A) and 84 patients in the rein-type capsular suture group (group B). The mean follow-up time exceeded three years for both groups. There was a minimal difference regarding QuickDASH score, visual analogue scale for pain, and grip strength ratio between the two groups. The rein-type group had significantly better Modified Mayo Wrist Score. The suture anchor group showed better distal radioulnar joint stability with dynamic ultrasound, but was more limited in ulnar deviation. However, these differences are most likely clinically insignificant. CONCLUSIONS: Both suture anchor repair and rein-type capsular suture yielded satisfactory results for TFCC 1B foveal tear in a minimum of 2-year follow-up. The functional scores were similar, and no major complications or recurrent instability were noted in either group. TYPE OF STUDY/LEVEL OF EVIDENCE: Retrospective Therapeutic Comparative Investigation IV.

An All-Arthroscopic Technique of Repairing Foveal Tears of the Triangular Fibrocartilage Complex Using a Bone Anchor-Repair Made Simple.

Traumatic foveal tears of the triangular fibrocartilage complex lead to ulnar-sided wrist pain and instability, resulting in painful motion and loss of grip strength with a severe impact on the overall function of the upper limb. Surgical repair is nothing new and has traversed through the realm of open repair to arthroscopic assisted to all arthroscopic repair techniques over the many decades, with arthroscopic repairs showing better visualization, lesser trauma, and equally favorable patient outcomes. Techniques had varied from using trans osseous tunnels to bone anchors, with or without the usage of special jigs. Here, we describe a simple and fast 3 portal arthroscopic technique of repairing the torn foveal insertion of the triangular fibrocartilage complex using a bone anchor inserted under arthroscopic and fluoroscopic guidance into the fovea. Both the dorsal and volar limbs of the triangular fibrocartilage complex are repaired arthroscopically, resulting in a strong anatomic repair resulting in a stable and pain-free wrist.

Wrist Arthroscopy-Assisted Reduction for Distal Radius Fracture and its Associated Injuries: Clinical Observation of Triangular Fibrocartilage Complex Injuries.

BACKGROUND: To compare the clinical effects between wrist arthroscopy-assisted open reduction plus internal fixation, using the triangular fibrocartilage complex (TFCC) as an example, and simple open reduction plus internal fixation in the treatment of distal radius fractures (DRFs). The study aims to assess the efficacy of arthroscopic-assisted open reduction and internal fixation in treating distal radius fractures. METHODS: The study utilized a retrospective cohort research approach, involving 60 patients treated at Binzhou Medical University Hospital between August 2021 and October 2022. These patients met the specified criteria and underwent two distinct surgical procedures for DRFs. Prior to surgery, thorough communication was established with the patients to elucidate the advantages, risks, and associated costs of wrist arthroscopy, and informed consent was obtained. Subsequent to the surgeries, postoperative follow-up was conducted to evaluate the variances between the two treatment modalities. Postoperative analysis and assessment encompassed the patients' Visual Analogue Scale (VAS) scores, Cooney wrist scores, grip strength of the affected limb (in comparison with the healthy side), wrist range of motion, and the frequency of intraoperative fluoroscopy usage. RESULTS: No surgical complications were observed among all patients. They were followed up for an average duration of (12.1 ± 1.3) months postoperatively, during which all fractures healed successfully. Within the treatment group, arthroscopy detected 14 cases of TFCC tears during the operation, all of which were repaired under a microscope. Conversely, physical examination identified three cases of TFCC injury in the control group, which were treated via incision and suture. At the 3-month postoperative mark, the treatment group exhibited significantly superior comprehensive scores for wrist pain, grip strength, and wrist range of motion compared to the control group (p < 0.05). Cooney's comprehensive wrist joint scoring yielded the following results: treatment group - excellent in 21 cases, good in five cases, and moderate in four cases; control group - excellent in 16 cases, good in nine cases, and moderate in five cases. CONCLUSION: Wrist arthroscopy-assisted surgery facilitates precise reduction of the articular surface and alleviation of intraarticular congestion. Moreover, it enables evaluation and repair of concurrent intra-articular injuries such as TFCC tears and other tissue injuries, thereby reducing the likelihood of chronic wrist pain. Consequently, this technique should be deemed valuable in clinical practice owing to its outstanding clinical efficacy.

Triangular fibrocartilage complex injury: outcomes of operative and non-operative management.

OBJECTIVE: The prevalence TFCC injuries has increased over time. However, there remains a lack of understanding of its natural history. Along with the paucity of evidence on treatment options, there is lack of consensus on how best to manage them. This is a retrospective study with subgroup cohort analysis, examining variables and management options associated with patient-reported disability and pain. METHODS: Patients from a metropolitan health network who have been referred for Magnetic Resonance Imaging (MRI) of the wrist between 2010 and 2019 and identified to have TFCC injury, were followed up to determine patient-reported outcomes. Disability of arm shoulder and hand scores (DASH) and visual assessment pain scale (VAS) were used to measure disability and pain respectively. An 'excellent' DASH and VAS scores were defined as ≤10 and ≤2, respectively. RESULTS: One hundred and twenty-four patients met the inclusion criteria and consented to participate in this study. There were 53 patients with excellent DASH score, 95 excellent VAS score and 51 excellent outcomes at mean follow-up of 75.5 months (Range: 5-402.8 months). Concomitant pathology and surgical management were less likely to have excellent DASH and VAS scores, while traumatic aetiology and smoking were less likely to have excellent VAS score. Age was not predictive of excellent DASH or VAS score. CONCLUSIONS: Surgical management of TFCC injuries were associated with worse outcomes than if they were left alone. Smoking cessation is a patient-modifiable risk factor that may help improve outcomes.

Prevalence of asymptomatic TFCC tears on MRI: A systematic review.

BACKGROUND: Recent studies show a high prevalence of triangular fibrocartilage complex (TFCC) tears in asymptomatic wrists. While a TFCC tear may be identified when evaluating ulnar sided wrist pain, this could be incidental and not the true cause of pain. The purpose of this review was to (1) examine the frequency of which TFCC tears are diagnosed on MRI in asymptomatic versus symptomatic wrists and (2) determine whether rates of asymptomatic TFCC tears are higher in two important subgroups commonly at risk for this pathology: elderly patients and high-impact athletes. METHODS: Articles of level IV or higher evidence were selected from PubMed, Ovid MEDLINE, and Cochrane Central Register of Controlled Trials Database to compare patient demographics, study parameters, and clinical outcomes. RESULTS: Seven studies met inclusion criteria with a total of 501 wrists (205 symptomatic and 296 asymptomatic). All studies included asymptomatic patients with wrist MR imaging and included information on the structural integrity of the TFCC. Variability in outcome measures reported across studies prevented the conduction of a meta-analysis. CONCLUSIONS: TFCC abnormalities are present in patients of all ages, symptomatology, and levels of involvement in high-impact sports. Although, there are differences in tear and abnormality prevalence when comparing these three factors, the difference was not significant. Given these findings, using MRI to assess ulnar-sided wrist pain should be fortified with clinical suspicion, physical exam, and physician judgment.

Complications after arthroscopic triangular fibrocartilage complex (TFCC) surgery.

Wrist arthroscopy is a valuable and widely utilized tool in the treatment of triangular fibrocartilage complex (TFCC) injuries. These procedures include synovectomy alone, peri-capsular or transosseous repair, and arthroscopic-assisted reconstruction, and each are associated with specific complications. This review describes the types of complications and their rates in different types of arthroscopic TFCC surgery reported in the literature and in our centre. Across the spectrum of arthroscopic TFCC surgery, complication rates and the learning curve increase with surgical complexity. Relevant anatomy, prevention and management of complications including nerve injury and irritation, extensor tendon injury and tendinitis, fracture, stiffness, and persistence of symptoms or instability are discussed. Vigilance to anatomical details and careful dissection can help to reduce complications that may result in disturbing pain and functional loss.

[Comparative study of short-term effectiveness of three surgical methods for ulnar styloid base fracture complicated with triangular fibrocartilage complex injury].

Objective: To compare the short-term effectiveness of arthroscopic suture of triangular fibrocartilage complex (TFCC), arthroscopic suture of TFCC combined with open reduction and internal fixation, and simple open reduction and internal fixation in the treatment of distal radius fractures combined with ulnar styloid base fractures and TFCC injury. Methods: A clinical data of 97 patients with distal radius fractures combined with ulnar styloid base fracture and TFCC injury, who were admitted between September 2019 and September 2022 and met the selective criteria, was retrospectively analyzed. After reduction and internal fixation of distal radius fractures, 37 cases underwent arthroscopic suture of TFCC (TFCC group), 31 cases underwent arthroscopic suture of TFCC combined with open reduction and internal fixation of ulnar styloid base fractures (combination group), and 29 cases underwent simple open reduction and internal fixation of ulnar styloid base fractures (internal fixation group). There was no significant difference in baseline data between groups ( P>0.05), such as gender, age, injury side, time from injury to operation, and preoperative radius height, palm inclination, ulnar deviation, grip strength, wrist range of motion (ROM) in rotation, ulnar-radial deviation, and flexion-extension. The differences (change value) in radius height, metacarpal inclination angle, ulnar deviation angle, grip strength, and wrist ROM in rotation, ulnar-radial deviation, and flexion-extension between preoperative and 12 months after operation in 3 groups were compared. The effectiveness was evaluated according to the modified Gartland-Werley score at 12 months after operation. Results: All incisions healed by first intention. All patients were followed up 12-18 months (mean, 14 months). X-ray films showed that there were 4 patients with non-union of ulnar styloid base fracture in TFCC group, and the remaining patients had fracture healing at 3 months after operation. The radius height, palm inclination, and ulnar deviation of 3 groups at 12 months after operation were significantly better than those before operation ( P<0.05); however, the differences in the change values of the above indexes between groups was not significant ( P>0.05). At 12 months after operation, the change values of wrist ROM in rotation, ulnar-radial deviation, and flexion-extension in the TFCC group and the combination group were significantly greater than those in the internal fixation group ( P<0.05), and there was no significant difference between the TFCC group and the combination group ( P>0.05). The change values of grip strength was significantly greater in the combination group than in the internal fixation group ( P<0.05); there was no significant difference between the other groups ( P>0.05). The excellent and good rates according to the modified Gartland-Werley score were 91.89% (34/37), 93.54% (29/31), and 72.41% (21/29) in the TFCC group, the combination group, and the internal fixation group, respectively. The excellent and good rates of the TFCC group and the combination group were significantly higher than that of the internal fixation group ( P<0.05); there was no significant difference between the TFCC group and the combination group ( P>0.05). Conclusion: For ulnar styloid base fractures with TFCC injury, compared with simple open reduction and internal fixation, arthroscopic suture of TFCC or suture TFCC combined with internal fixation treatment are both beneficial for wrist function recovery, and their short-term effectiveness are similar. Therefore, arthroscopic suture of TFCC may be a better choice.

Post-surgical Rehabilitation Guidelines for Triangular Fibrocartilage Complex Foveal Repair: A Survey of Australian Hand and Wrist Surgeons.

Background: To restore distal radioulnar joint stability following injury to the Triangular Fibrocartilage Complex (TFCC), foveal repair surgery may be necessary. Post-surgery rehabilitation is prescribed to restore wrist and hand function; however, no universally accepted or definitive rehabilitation protocol currently exists. The aim of this study was to survey hand and wrist surgeons regarding their recommended postoperative rehabilitation protocols following TFCC foveal repair surgery. Methods: Australian hand and wrist surgeons were invited to complete a descriptive survey containing 10 questions. Questions included clinical recommendations for wrist and forearm immobilisation, range of motion (ROM) exercise timeframes and surgeon experience of TFCC rupture. Descriptive statistics and between-group (TFCC rupture vs. no-rupture) comparisons (Pearson's Chi2) were calculated. Results: Thirty-one surgeons completed the survey. Recommendations for post-surgery immobilisation ranged from 'not required' to 8 weeks (mode 6 weeks). Wrist and forearm ROM commencement time ranged from 'immediately' to 'later than 8 weeks' (mode 6 weeks). The most recommended orthosis was a 'sugar-tong' (57%). Thirty-seven percent (37%) reported experience of post-surgery re-rupture. Conclusions: While surgeon recommendations varied, the majority recommended 4- to 6-week timeframe for immobilisation and ROM exercise commencement. Additional clinical research is recommended to evaluate whether postoperative rehabilitation decisions influence patient outcomes. Level of Evidence: Level V (Therapeutic).

Prognostic factors for clinical outcomes after arthroscopic treatment of traumatic central tears of the triangular fibrocartilage complex.

Aims: The study aimed to assess the clinical outcomes of arthroscopic debridement and partial excision in patients with traumatic central tears of the triangular fibrocartilage complex (TFCC), and to identify prognostic factors associated with unfavourable clinical outcomes. Methods: A retrospective analysis was conducted on patients arthroscopically diagnosed with Palmer 1 A lesions who underwent arthroscopic debridement and partial excision from March 2009 to February 2021, with a minimum follow-up of 24 months. Patients were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Mayo Wrist Score (MWS), and visual analogue scale (VAS) for pain. The poor outcome group was defined as patients whose preoperative and last follow-up clinical score difference was less than the minimal clinically important difference of the DASH score (10.83). Baseline characteristics, arthroscopic findings, and radiological factors (ulnar variance, MRI, or arthrography) were evaluated to predict poor clinical outcomes. Results: A total of 114 patients were enrolled in this study, with a mean follow-up period of 29.8 months (SD 14.4). The mean DASH score improved from 36.5 (SD 21.5) to 16.7 (SD 14.3), the mean MWS from 59.7 (SD 17.9) to 79.3 (SD 14.3), and the mean VAS pain score improved from 5.9 (SD 1.8) to 2.2 (SD 2.0) at the last follow-up (all p < 0.001). Among the 114 patients, 16 (14%) experienced poor clinical outcomes and ten (8.8%) required secondary ulnar shortening osteotomy. Positive ulnar variance was the only factor significantly associated with poor clinical outcomes (p < 0.001). Positive ulnar variance was present in 38 patients (33%); among them, eight patients (21%) required additional operations. Conclusion: Arthroscopic debridement alone appears to be an effective and safe initial treatment for patients with traumatic central TFCC tears. The presence of positive ulnar variance was associated with poor clinical outcomes, but close observation after arthroscopic debridement is more likely to be recommended than ulnar shortening osteotomy as a primary treatment.

Effectiveness of suture anchor and transosseous suture technique in arthroscopic foveal repair of the triangular fibrocartilage complex: a systematic review.

BACKGROUND: Currently, there were two major surgical methods for arthroscopic triangular fibrocartilage complex (TFCC) foveal repair: suture anchor (SA) and transosseous suture (TOS). The purpose of this systematic review is to examine the relevant outcome improvement and safety of SA and TOS technique. METHODS: Literature review of electronic databases for studies investigating the effects of SA and TOS in patients undergoing arthroscopic TFCC foveal repair was performed. We compared the pre-operative and postoperative functional outcomes, clinical outcomes [pain, range of motion (ROM) and grip strength], and complications of two methods. Minimal clinically important difference (MCID) was used to determine clinically meaningful improvement. RESULTS: There were 1263 distinct studies identified, with 26 (904 patients) meeting the inclusion criteria. The mean age of participants ranged from 21.4 to 41 years, and the mean follow-up time ranged from 6 to 106 months. Both SA and TOS groups reported significant improvement in the modified mayo wrist score, the disabilities of the arm, shoulder, and hand (DASH) score, quick DASH score, patient-reported wrist evaluation (PRWE) score, and the visual analog scale (VAS) score. According to MCID, all the studies from both groups reporting DASH, quick DASH, PRWE and VAS score achieved clinically meaningful improvement. (MCID: 10 for DASH, 14 for quick DASH, 14 for PRWE and 1.6-18 for VAS). The ROM changes in both groups varied from improvement to deterioration. Grip strength improved in both SA and TOS group. Most complications were self-limited. The reoperation rates in SA and TOS ranged from 0 to 20% and 0 to 27.3%, respectively. CONCLUSIONS: Both SA and TOS technique for arthroscopic TFCC foveal repair could achieve improvement in postoperative functional outcomes, pain, and grip strength with low reoperation rate. However, the ROM improvement was still inconclusive. LEVEL OF EVIDENCE IV: Systematic review of level III and IV studies.

Management of Ulnar Styloid Nonunions.

Ulnar styloid fractures commonly occur in the setting of distal radius fractures and often progress to asymptomatic nonunion. Displaced basilar ulnar styloid fractures involving the deep radioulnar ligament attachments may cause distal radioulnar joint (DRUJ) instability. A careful clinical history, physical examination, review of imaging studies, and selected diagnostic interventions are important for confirming the relationship of the ulnar styloid nonunion with ulnar-sided wrist symptoms and/or DRUJ instability. Improved functional and symptomatic outcomes can be achieved with nonunion repair or fragment excision with or without triangular fibrocartilage complex repair, depending on the location and size of the ulnar styloid fracture.

Acute blockage of forearm supination due to flap tear of the triangular fibrocartilage disc: A case report.

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.

Resultados del anclaje foveal artroscópico sin nudo del complejo del fibrocartílago triangular en lesiones Atzei 2/3 / Results of the knotless arthroscopic foveal anchorage of the triangular fibrocartilage complex in Atzei 2/3 lesions

Objetivo: Evaluar, en forma retrospectiva, la función y los resultados objetivos de los pacientes con lesión foveal del complejo del fibrocartílago triangular mediante anclaje óseo sin nudo artroscópico. Materiales y métodos: Se evaluó, en forma retrospectiva, a 12 pacientes con lesión foveal del complejo del fibrocartílago triangular Atzei 2/3 y un seguimiento promedio de 18 meses. Todas las lesiones se repararon con artroscopia mediante la guía de fibrocartílago y anclaje óseo sin nudo. Se evaluaron los rangos de movilidad y la fuerza de agarre con la escala de muñeca de la Clínica Mayo y el cuestionario DASH. Resultados: Se obtuvieron mejoras en la prueba del dolor y la fuerza; el rango de movilidad promedio fue de 70° de extensión, 85° de flexión, 20° de desviación radial y 30° de desviación cubital. Los resultados según la escala de muñeca de la Clínica Mayo fueron excelentes en el 83% y buenos en el 17%, no hubo resultados malos. El puntaje promedio del cuestionario DASH fue 56 en el preoperatorio y 8 en el posoperatorio. El promedio de la fuerza comparativa contralateral fue del 70%. Conclusiones: La reparación artroscópica de las lesiones Atzei 2/3 mediante anclaje óseo sin nudo logra buenos resultados, mejora los rangos de movilidad, recupera la estabilidad en todos los casos y la fuerza total o parcial. Nivel de Evidencia: IV

Objective: To retrospectively evaluate the functional and objective outcomes in patients with foveal lesions of the triangular fibrocartilage complex treated with arthroscopic knotless bone anchors. Materials and methods: We retrospectively evaluated 12 patients with Atzei 2/3 foveal lesions of the triangular fibrocartilage complex with an average follow-up of 18 months. All the lesions were repaired arthroscopically using a fibrocartilage guide and knotless bone anchors. The ranges of motion and grip strength were assessed with the Mayo Clinic wrist scale and the DASH questionnaire. Results: Improvements were obtained in the pain and strength test; the average range of motion was 70° in extension, 85° in flexion, 20° in radial deviation, and 30° in ulnar deviation. The outcomes according to the Mayo Clinic wrist scale were excellent in 83% of the cases and good in 17%; there were no poor outcomes. The average DASH score was 56 preoperatively and 8 postoperatively. The average contralateral comparative strength was 70%. Conclusion: The arthroscopic repair of Atzei 2/3 lesions with knotless bone anchors achieves good outcomes, improves ranges of motion, and restores stability and total or partial strength in all cases. Level of Evidence: IV

Resultados del tratamiento artroscópico de lesiones del complejo fibrocartílago triangular en lesiones Palmer 1D mediante anclaje óseo sin nudo / Arthroscopic treatment of triangular fibrocartilage complex injuries with bone anchor without knot

Introducción: El complejo fibrocartílago triangular (CFCT) mantiene la estabilidad de la articulación radiocubital distal (ARCD). El CFCT radial esta irrigado por la arteria interósea anterior. Una lesión radial con inestabilidad radiocubital distal debe reparase, al igual que una lesión central, para que no continúe hacia los ligamentos generando inestabilidad.Materiales y métodos: se desarrolló un estudio retrospectivo para analizar las cirugías realizadas en pacientes con lesiones del CFCT radiales Palmer 1D. Se estudiaron once pacientes masculinos de 32.8 años promedio. Todos los pacientes eran trabajadores de fuerza y el 72.7%, deportistas. El seguimiento promedio fue de 18.4 meses.Resultados: fueron evaluados once pacientes. El 63.6% de manos hábiles. El 100% de ellos presentó una lesión 1D de Palmer. La escala visual analógica del dolor preoperatorio era de 8 y postoperatoria fue de 1. El Dash score fue de 85.8 preoperatorio y de 1.18 en el postoperatorio. El score de Mayo de muñeca fue excelente en seis pacientes y bueno en cinco.Conclusión: los ligamentos radiocubitales volares y dorsales son fundamentales para mantener una adecuada estabilidad radiocubital distal ya que poseen una irrigación adecuada que permite su reparación, por lo que su reanclaje está indicado. La técnica artroscópica sin realizar túnel, expuesta en este trabajo, permite un reanclaje del CFCT sin manejos complejos con muy buenos resultados en la mayoría de los casos. Nivel de Evidencia: IV

Introduction: The triangular fibrocartilage complex (CFCT) maintains the stability of the distal radioulnar joint (ARCD). The radial CFCT is supplied by the anterior interosseous artery. A radial injury with distal radioulnar instability must be repaired, as well as a central injury, so that it does not continue towards the ligaments generating instability. Materials and methods: A retrospective study were developed to analyze the surgeries performed in patients with Palmer 1D radial CFCT lesions. Eleven male patients of 32.8 years average age were studied. All the patients were strength workers and 72.7% were athletes. The average follow-up was 18.4 months. Results: eleven patients of working age. 63.6% of skilled hands. 100% of patients presented a 1D Palmer lesion. The visual analog scale of preoperative pain was 8 and postoperative was 1. The Dash score was 85.8 preoperative and 1.18 postoperative. The May wrist score was excellent in six patients and good in five. Conclusion: the dorsal and radiocubital ligaments are essential to maintain adequate distal radiocubital stability and that they have adequate irrigation that allows their repair, for which reason their re-clamping is indicated. The arthroscopic technique without tunnel exposed in this work allows the CFCT to be re-anchored without tunnels and complex techniques with very good results in most cases. Level of Evidence: IV

Impactación cubitocarpiana / Ulnocarpal impaction

El objetivo de este artículo es actualizar los conocimientos sobre la impactación cubitocarpiana y su tratamiento. Estudios clásicos sobre la biomecánica del borde cubital de la muñeca han demostrado que los cambios milimétricos en la relación de longitud entre el cúbito y el radio alteran significativamente la transferencia de cargas entre los huesos del carpo, el radio y el cúbito. Así, un aumento relativo en la longitud del cúbito generará una carga excesiva sobre la articulación cubitocarpiana que producirá un espectro de cambios degenerativos progresivos en el domo cubital, el semilunar, el piramidal y el complejo del fibrocartílago triangular que finalizarán con artrosis cubitocarpiana y radiocubital distal. La impactación cubitocarpiana, en sus diversos estadios degenerativos, se puede tratar mediante osteotomías que buscan descomprimir la carga cubitocarpiana. Las osteotomías pueden ser extrarticulares o intrarticulares. Entre las extrarticulares, están las diafisarias, las metafisarias sin exposición articular (subcapitales) y las metafisarias distales con exposición articular y, entre las intrarticulares, la cirugía de resección en oblea (wafer), que reseca cartílago y hueso subcondral del domo cubital, y puede ser un procedimiento abierto o artroscópico. Si hay artrosis radiocubital distal, solo se podrá tratar con cirugías de rescate, como Darrach, Sauvé-Kapandji, Bowers, o una prótesis radiocubital distal. Estas técnicas de osteotomía se han analizado detalladamente para lograr definir sus ventajas y desventajas. Finalmente se propone una forma de tipificar la impactación cubitocarpiana, cuyo objetivo es orientar al lector hacia el mejor tratamiento posible, avalado por la bibliografía actual. Nivel de Evidencia: V

The purpose of this article is to provide updated knowledge about ulnocarpal impaction syndrome (UCIS) and its treatment. Classic studies on biomechanics of the ulnar side of the wrist have shown that millimetrical changes in the relative lengths of the ulna and the radius significantly alter the load transmission between the carpal bones, the radius and the ulna. Thus, an increase in the relative length of the ulna will generate an excessive load on the ulnocarpal joint, which will produce a spectrum of progressive degenerative changes in the ulnar dome, lunate, triquetrum, and the triangular fibrocartilage complex (TFCC), that will lead to ulnocarpal and distal radioulnar joint (DRUJ) osteoarthritis. In its various degenerative stages, UCIS can be treated with osteotomies that seek to decompress the ulnocarpal load. These can be extra-articular or intra-articular. Within the extra-articular osteotomies, we find the diaphyseal, metaphyseal without joint exposure (subcapital), and the distal metaphyseal with joint exposure. Within the intra-articular ones, we find the wafer procedure, which resects the cartilage and subchondral bone of the ulnar dome, and can be performed either openly or arthroscopically. If there is associated DRUJ osteoarthritis, it can only be treated with salvage surgeries such as the Darrach, Sauvé-Kapandji, and Bowers procedures, or a DRUJ arthroplasty. These osteotomy techniques will be analyzed in detail in order to define their advantages and disadvantages. Finally, we propose a way to typify the UCIS to guide the reader towards the best possible treatment supported by current literature. Level of Evidence: V

Resultados de la reparación con sutura artroscópica de las lesiones periféricas cubitales del complejo fibrocartílago triangular (CFCT) (Palmer 1B/Atzei 1) / Arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears

INTRODUCCIÓN: Las Lesiones del Complejo Fibrocartílago Triangular (CFCT) son causa común de dolor Ulnar en la muñeca, la artroscopia es el estándar de oro para el diagnóstico y tratamiento de las mismas. Realizamos un trabajo retrospectivo evaluando la función y resultados de los pacientes operados con técnica artroscópica con la lesión CFCT Palmer 1B/Atzei 1. MATERIAL Y MÉTODO: Evaluamos 24 pacientes con 25 lesiones de CFCT palmer 1B/Atzei 1. El 88% en edad laboral entre 19 a 57 años (34 años promedio) con un seguimiento promedio de 9 meses. Todas las lesiones fueron reparadas con técnicas artroscópicas y puntos de sutura adentro afuera y afuera adentro. Se evaluó el Rango de Movilidad (ROM), fuerza de agarre, escala de Mayo de Muñeca y escala de DASH. RESULTADOS: Hemos tenido mejoras en test del dolor y la fuerza, el ROM promedio fue 70° para la extensión, 85° de flexión, 20° para la desviación radial y 30° de desviación cubital. El Score de muñeca de mayo fue excelente en el 64%, Bueno en el 16%, Satisfactorio en el 20% y no hemos tenido malos resultados. Nuestro Dash Score pre operatorio fue de 86 puntos y en el Post operatorio de 13 puntos. El promedio de la fuerza comparativa contralateral fue del 70%. CONCLUSIÓN: La reparación artroscópica de las lesiones Palmer 1B/ Atzei 1 dan resultados satisfactorios mejorando los ROM, recuperando la fuerza de forma total o parcial y disminuyendo el dolor. Encontramos que el tiempo entre la cirugía y los resultados obtenidos influye en los resultados y cuanto mayor es el seguimiento mejor los resultados. Tipo de estudio: Serie de casos. Nivel de evidencia: IV.

OBJECTIVE: Lesions of the Triangular Fibrocartilage Complex (CFCT) are a common cause of ulnar pain in the wrist; arthroscopy is the gold standard for the diagnosis and treatment of them. We performed a retrospective study evaluating the function and results of patients operated with an arthroscopic technique with Palmer 1B / Atzei 1 lesion. MATERIAL AND METHODS: We evaluated 24 patients with 25 CFCT lesions palmer 1B / Atzei 1. 88% of working age between 19 to 57 years old (average 34 years) with a follow-up of 9 months. All injuries were repaired with arthroscopic techniques and stitches inside and outside inside. The Mobility Range (ROM), grip strength, May Wrist score and the DASH Score were evaluated. RESULTS: We have had improvements in pain and strength tests, the average ROM was 70 ° for extension, 85 ° for flexion, 20° for radial deviation and 30 ° for ulnar deviation. The Wrist Score of May was excellent at 64%, Good at 16%, Satisfactory at 20% and we have not had bad results. Our preoperative Dash Score was 86 points and in the Post-operative of 13 points. The average of the contralateral comparative force was 70%. CONCLUSION: The arthroscopic repair of the Palmer 1B / Atzei 1 lesions gives satisfactory results improving the ROM, recovering the strength totally or partially and decreasing the pain. We found that the time between surgery and the results obtained influences the results and the greater the follow-up the better the results. Type study: Number of cases. Level of evidence: IV.