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R Schmitt
The distal radioulnar joint, the triangular fibrocartilage complex (TFCC) and the wrist are stabilized by many ligaments allowing not only a wide range of motion but also providing sufficient stability. The complex arrangement of carpal ligaments and prosupination around the forearm joint enables multiaxial motion patterns. In the wrist, intra-articular ligaments can be differentiated from extra-articular capsular ligaments as well as intrinsic and extrinsic ligament courses. Imaging is essential for classification of dynamic and static instability patterns...
December 1, 2016: Der Radiologe
D Fontès
Distal radius fracture is actually quite rarely isolated and triangular fibrocartilaginous complex (TFCC) is often involved with the same mechanism of injury. A contemporary management of the treatment of the initial fracture is ideal and so benefits from a routine arthroscopic management. Nevertheless, in the absence of diagnosis and therefore early treatment, the symptoms may be located at the ulnar crossroads and justify specific treatment of TFCC. It is generally conducted after an accurate arthroscopic lesion classification guiding a procedure, depending on the lesion vascularization as well as its possible destabilization potential (debridement, capsular suture or foveal reattachment)...
December 2016: Hand Surgery and Rehabilitation
Maysara Abdelhalim Bayoumy, Hesham A Elkady, Hatem G Said, Amr El-Sayed, Waleed Riad Saleh
BACKGROUND: There has been controversy regarding the pathogenesis and treatment of TFCC tear. Different surgical techniques for the treatment of TFCC are prescribed. The purpose of this study was to evaluate the short-term outcomes of arthroscopic outside-in repair of the ulnar side TFCC tear with vertical mattress suture. METHODS: In this study, arthroscopic outside-in repair of the ulnar side TFCC tear was done. 37 patients with TFCC tear with failure of conservative treatment for a minimum of 6 months had surgery...
December 2016: Journal of Orthopaedics
Marshall A Kuremsky, Nahir Habet, Richard D Peindl, R Glenn Gaston
PURPOSE: To quantify the distance of the dorsal ulnar sensory branch, floor of the extensor carpi ulnaris (ECU) subsheath, and ulnar neurovascular bundles from the triangular fibrocartilage complex (TFCC), and secondarily to assess the safety of an all-inside arthroscopic repair of the TFCC with a commonly used meniscal repair device with respect to the aforementioned structures. METHODS: A custom K-wire with 1-mm gradation was used to determine the distance of at-risk structures from the periphery of the TFCC in 13 above-elbow human cadaver specimens...
September 7, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Midum Jegal, Kang Heo, Jong Pil Kim
The importance of foveal repair of the triangular fibrocartilage complex (TFCC) on stability of the distal radioulnar joint (DRUJ) has been emphasized with increasing knowledge of the anatomy and biomechanics of the TFCC and DRUJ. Although both open and arthroscopic techniques have been described for improving DRUJ stability, there has been a marked evolution of arthroscopic TFCC repair technique with successful clinical outcome. Recently, an arthroscopic trans-osseous technique has been described to repair foveal tears of the TFCC...
October 2016: J Hand Surg Asian Pac Vol
Donald von Borstel, Michael Wang, Kirstin Small, Taiki Nozaki, Hiroshi Yoshioka
This study is intended as a review of 3Tesla (T) magnetic resonance (MR) imaging of the triangular fibrocartilage complex (TFCC). The recent advances in MR imaging, which includes high field strength magnets, multi-channel coils, and isotropic 3-dimensional (3D) sequences have enabled the visualization of precise TFCC anatomy with high spatial and contrast resolution. In addition to the routine wrist protocol, there are specific techniques used to optimize 3T imaging of the wrist; including driven equilibrium sequence (DRIVE), parallel imaging, and 3D imaging...
August 16, 2016: Magnetic Resonance in Medical Sciences: MRMS
Sualp Turan, Deniz Çankaya, Serdar Yılmaz, Dilek Karakuş, Abdurrahim Dündar, Güzelali Özdemir
OBJECTIVES: This study aims to investigate the effect of accompanying ulnar styloid fracture (USF) on clinical outcomes and hand-wrist muscle strength in conservatively treated active patients after displaced distal radius fracture (DRF). PATIENTS AND METHODS: The retrospective study, which was conducted November 2012 and September 2016, included 56 patients (34 males, 22 females; mean age 28.8 years; range 20 to 40 years) with displaced DRF treated with closed reduction and casting...
August 2016: Eklem Hastalıkları Ve Cerrahisi, Joint Diseases & related Surgery
T Pillukat, R A Fuhrmann, J Windolf, J van Schoonhoven
OBJECTIVE: Refixation of the triangular fibrocartilage complex (TFCC) to the ulnar capsule of the wrist. INDICATIONS: Distal TFCC tears without instability, proximal TFCC intact. Loose ulnar TFCC attachment without tear or instability. CONTRAINDICATIONS: Peripheral TFCC tears with instability of the distal radioulnar joint (DRUJ). Complex or proximal tears of the TFCC. Isolated, central degenerative tears without healing potential. SURGICAL TECHNIQUE: Arthroscopically guided, minimally invasive suture of the TFCC to the base of the sixth extensor compartment...
August 2016: Operative Orthopädie und Traumatologie
T Del Gaudio, M Haerle
OBJECTIVE: Arthroscopic decompression (wafer procedure) of the ulnocarpal compartment in patients with ulnar impaction syndrome. INDICATIONS: The arthroscopic wafer procedure is recommended in ulnar-plus situations with up to 3 mm length-excess. To perform this procedure the ulnar head needs to be accessible for the burr through a pre-existing, impaction-related, centroradial lesion of the triangular fibrocartilage complex (TFCC). The additional presence of a distal radioulnar joint (DRUJ) type C confirms the indication...
August 2016: Operative Orthopädie und Traumatologie
N Schmelzer-Schmied
OBJECTIVE: The goal of this operation technique is a stable refixation of the triangular fibrocartilage complex (TFCC) to the fovea ulnaris. The stability of the distal radio-ulnar joint (DRUJ) should be re-established. The patients pain and the feeling of instability should be reduced. INDICATIONS: Lesions of the foveal component of the TFCC resulting in DRUJ instability. Combined lesions of both components of the TFCC. Complete detachment of the TFCC from the ulna either without fracture of the styloid process of the ulna or with fracture (floating styloid)...
August 2016: Operative Orthopädie und Traumatologie
Tadanobu Onishi, Shohei Omokawa, Akio Iida, Yasuaki Nakanishi, Tsutomu Kira, Hisao Moritomo, Sompob Ruxasagluwang, Jirchart Kraisarin, Takamasa Shimizu, Yasuhito Tanaka
We investigated the reliability and accuracy of the distal radioulnar joint (DRUJ) ballottement test using five fresh-frozen cadaver specimens in triangular fibrocartilage complex (TFCC)-intact, and TFCC-sectioned wrists. The humerus and proximal ulna were fixed. The ulna was allowed to translate in dorsopalmar directions without rotation, and the radius was allowed to move freely. Four sensors of a magnetic tracking system were attached to the radius and ulna, and the nails of each examiner's thumbs. Five examiners conducted the DRUJ ballottement test before and after TFCC sectioning...
June 29, 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Sung Jong Woo, Midum Jegal, Min Jong Park
BACKGROUND: Disruption of the triangular fibrocartilage complex (TFCC) foveal insertion can lead to distal radioulnar joint (DRUJ) instability accompanied by ulnar-sided pain, weakness, snapping, and limited forearm rotation. We investigated the clinical outcomes of patients with TFCC foveal tears treated with arthroscopic-assisted repair. MATERIALS AND METHODS: Twelve patients underwent foveal repair of avulsed TFCC with the assistance of arthroscopy between 2011 and 2013...
May 2016: Indian Journal of Orthopaedics
H L Zhan, Y Liu, R J Bai, Z H Qian, W Ye, Y X Li, B D Wu
OBJECTIVE: To explore the MRI characteristics of injuries of triangular fibrocartilage complex (TFCC), and provide imaging basis for the early diagnosis and treatment of the injuries. METHODS: A total of 10 healthy volunteers without wrist injuries and 200 patients from Beijing Jishuitan Hospital who complained ulnar-sided wrist pain and were highly suspected as the injury of TFCC underwent the wrist magnetic resonance examination. All subjects were in a prone position and underwent examination on coronal T1WI scan and PD-FS on 3 planes respectively...
June 7, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Young Sinn Kim, Je Hyeok Oh, Chan Woong Kim, Sung Eun Kim, Dong Hoon Lee, Jun Young Hong
This study compared the effectiveness two-finger chest compression technique (TFCC) performed using the right vs. left hand and the index-middle vs. middle-ring fingers. Four different finger/hand combinations were tested randomly in 30 healthcare providers performing TFCC (Test 1: the right index-middle fingers; Test 2: the left index-middle fingers; Test 3: the right middle-ring fingers; Test 4: the left middle-ring fingers) using two cross-over trials. The "patient" was a 3-month-old-infant-sized manikin...
June 2016: Journal of Korean Medical Science
M Lutz, S Erhart, C Deml, T Klestil
OBJECTIVE: Anatomical reconstruction of the distal radius after intra-articular fractures with special consideration of the articular surface and treatment of concomitant ligament injuries. INDICATIONS: Intra-articular distal radius fractures in adults under 65 years of age. CONTRAINDICATIONS: Osteoporotic deterioration of metaphyseal bone, radiocarpal fracture dislocation and open fractures. SURGICAL TECHNIQUE: Conventional palmar approach for plate fixation of the fracture with a fixed angle locking plate...
August 2016: Operative Orthopädie und Traumatologie
Susan J Barlow
BACKGROUND AND PURPOSE: The current literature contains no reports of treatment options other than surgery following failed conservative management of a triangular fibrocartilage complex (TFCC) tear. The purpose of this study is to describe the use of a novel brace as a non-surgical intervention for TFCC tears. METHODS: This paper is a case study of a subject with a magnetic resonance imaging-confirmed TFCC tear. As an alternative to surgery, he consented to wear a novel brace for 12 weeks after conservative management of his injury had failed...
December 2016: Physiotherapy Research International: the Journal for Researchers and Clinicians in Physical Therapy
C Rehnitz, B Klaan, F von Stillfried, E Amarteifio, I Burkholder, H U Kauczor, M A Weber
PURPOSE: To compare the image quality of modern 3 D and 2 D sequences for dedicated wrist imaging at 3 Tesla (T) MRI. MATERIALS AND METHODS: At 3 T MRI, 18 patients (mean age: 36.2 years) with wrist pain and 16 healthy volunteers (mean age: 26.4 years) were examined using 2 D proton density-weighted fat-saturated (PDfs), isotropic 3 D TrueFISP, 3 D MEDIC, and 3 D PDfs SPACE sequences. Image quality was rated on a five-point scale (0 - 4) including overall image quality (OIQ), visibility of important structures (cartilage, ligaments, TFCC) and degree of artifacts...
August 2016: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
Joong-Bae Seo, Jong-Pil Kim, Hyung-Suk Yi, Kwang-Hee Park
PURPOSE: The aim of this study was to compare the results of arthroscopic peripheral repair (AR) and arthroscopic debridement (AD) for the treatment of chronic unstable triangular fibrocartilage complex (TFCC) tears in ulnar-positive patients undergoing ulnar-shortening osteotomy (USO). METHODS: A total of 31 patients who underwent arthroscopic treatments combined with USO for unstable TFCC tears and were followed-up at a minimum of 24 months were included in this retrospective cohort study...
May 2016: Journal of Hand Surgery
A R Poublon, G Kraan, S P Lau, A L A Kerver, G-J Kleinrensink
The aim of this study was to define a detailed description of the dorsal cutaneous branch of the ulnar nerve (DCBUN) in particular in relevance to triangular fibrocartilage complex (TFCC) repairs. In 20 formalin-embalmed arms, the DCBUN was dissected, and the course in each arm was mapped and categorized. Furthermore, the point of origin of the DCBUN, that is, from the ulnar nerve in association with the ulnar styloid process, was defined. Finally, the distance between the ulnar styloid process and the branching of the radial-ulnar communicating branch (RUCB) and the first branch of DCBUN was measured...
July 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
D Schmauss, S Pöhlmann, J A Lohmeyer, G Germann, B Bickert, K Megerle
INTRODUCTION: The diagnostic value of clinical tests and magnetic resonance (MR) imaging for the investigation of triangular fibrocartilaginous complex (TFCC) lesions is not clear due to a lack of clinical data. MATERIALS AND METHODS: We retrospectively analyzed 908 patients who underwent clinical tests and arthroscopy for suspected TFCC lesions at our institution. Further, MR imaging findings concerning the TFCC were gathered. We correlated clinical tests and MR imaging findings with those obtained during arthroscopy, and we calculated sensitivity, specificity, as well as positive and negative predictive values...
June 2016: Archives of Orthopaedic and Trauma Surgery
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