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Triangular fibrocartilage

Jonny K Andersson, Martina Åhlén, Daniel Andernord
BACKGROUND AND PURPOSE: To investigate the outcome of open versus arthroscopic repair of injuries of the triangular fibrocartilage complex (TFCC). METHODS: An electronic literature search of articles published between January 1, 1985, and May 26, 2016, in PubMed, Embase, and the Cochrane Library was carried out in May 2016 and updated in March and December 2017. Studies comparing open and arthroscopic repair of TFCC injury with a mean follow up of more than 1 year were eligible for inclusion...
March 13, 2018: Journal of Experimental Orthopaedics
Georgios Filippou, Carlo Alberto Scirè, Antonella Adinolfi, Nemanja S Damjanov, Greta Carrara, George A W Bruyn, Tomas Cazenave, Maria Antonietta D'Agostino, Andrea Delle Sedie, Valentina Di Sabatino, Mario Enrique Diaz Cortes, Emilio Filippucci, Frederique Gandjbakhch, Marwin Gutierrez, Daryl K Maccarter, Mihaela Micu, Ingrid Möller Parera, Gaël Mouterde, Mohamed Atia Mortada, Esperanza Naredo, Carlos Pineda, Francesco Porta, Anthony M Reginato, Iulia Satulu, Wolfgang A Schmidt, Teodora Serban, Lene Terslev, Violeta Vlad, Florentin Ananu Vreju, Pascal Zufferey, Panagiotis Bozios, Carmela Toscano, Valentina Picerno, Annamaria Iagnocco
OBJECTIVES: To assess the reliability of the OMERACT ultrasound (US) definitions for the identification of calcium pyrophosphate deposition disease (CPPD) at the metacarpal-phalangeal, triangular fibrocartilage of the wrist (TFC), acromioclavicular (AC) and hip joints. METHODS: A web-based exercise and subsequent patient-based exercise were carried out. A panel of 30 OMERACT members, participated at the web-based exercise by evaluating twice a set of US images for the presence/absence of CPPD...
March 13, 2018: Annals of the Rheumatic Diseases
S Löw, C K Spies, F Unglaub, J Oppermann, M Langer, H Erne
BACKGROUND: The triangular fibrocartilage complex (TFCC) widens the radiocarpal joint and takes part in load transmission from the carpus to the forearm. It is thereby prone to degenerative changes. The painful situation that can accompany degeneration is called ulnar impaction. DIAGNOSIS: Clinical examination helps differentiate between various causes of ulnar-sided wrist pain. Standard X‑rays are needed to determine ulnar variance and stress radiographs can depict narrowing of the ulnocarpal joint space under load...
March 9, 2018: Der Orthopäde
Ji Hun Park, Dongmin Kim, Heesu Park, Inwon Jung, Inchan Youn, Jong Woong Park
PURPOSE: This study examined the influence of triangular fibrocartilage complex (TFCC) deep fiber tears on wrist proprioception. METHODS: The study involved 48 subjects: 24 with deep fiber TFCC tears and 24 with healthy wrists. A specially created sensor measured wrist proprioception in 3 axes of movement. Absolute differences between target and subject-reproduced angles were compared in injured and healthy wrists and in injured and contralateral patient wrists...
March 6, 2018: Journal of Hand Surgery
Francisco Del Piñal, Eduardo Moraleda, Jaime S Rúas, Ana Rodriguez-Vega, Alexis Studer
PURPOSE: To present a new arthroscopic method for treating supination losses. METHODS: Six patients (15-71 y) were eligible for this study. All had a history of trauma to the wrist more than 6 months previously. Five of them had sustained a distal radius fracture: 3 had been treated with a volar plate (1 of them for an extra-articular malunion), 1 with an external fixator and K-wires, and 1 had been treated in a cast. One of these patients underwent a further operation for correcting an intra-articular malunion...
March 6, 2018: Journal of Hand Surgery
A Arsalan-Werner, L Grüter, I M Mehling, W Moll, O Wölfle, M Sauerbier
INTRODUCTION: Injuries of the triangular fibrocartilage complex (TFCC) are of high clinical relevance; however, the clinical evidence for treatment is poor and long-term results are rarely published. The purpose of this study was to evaluate the clinical outcome of symptomatic central traumatic lesions of the TFCC (Palmer 1A) following arthroscopic debridement. MATERIALS AND METHODS: Between 2007 and 2013, 87 patients were arthroscopically diagnosed with Palmer 1A lesion and accordingly treated with debridement...
March 5, 2018: Archives of Orthopaedic and Trauma Surgery
Margaret Woon Man Fok, Christian Xinshuo Fang, Tak Wing Lau, Yin Keung Eric Fung, Boris Kwok Keung Fung, Frankie Ka Li Leung
PURPOSE: Distal radius fractures are associated with a high incidence of triangular fibrocartilage complex (TFCC) tears. This study aims to evaluate the status of TFCC after the healing of distal radius fractures, and its clinical significance. METHODS: Wrist arthroscopies were performed on 43 distal radius fractures, with an average age of 54 years old. RESULTS: Twenty-six complete tears and 15 partial healed tears were noted. Five out of eight patients with intact TFCC tears had neither signs nor symptoms, while eight patients with TFCC tears had no complaint...
February 23, 2018: International Orthopaedics
Daniel Tordjman, Richard M Hinds, S Steven Yang, John T Capo
Radial shaft convergence in distal radius fractures is often misdiagnosed. This common deformation is often associated with a radial translation of the distal fragment. This parameter has to be corrected because of the increased risk of distal radioulnar joint instability due to detensioning of the distal interosseous membrane if there is an associated triangular fibrocartilage complex lesion. A new radiologic sign for diagnosis of proximal radius convergence during distal radius fracture is presented as well as technical tips for correction of this deformity...
March 2018: Techniques in Hand & Upper Extremity Surgery
Matthew M Tomaino
Ulnar impaction syndrome is fundamentally a clinical diagnosis, which can be confirmed by magnetic resonance imaging. All palmer stages are amenable to surgical treatment with either arthroscopic wafer procedure (AWP) or ulnar shortening osteotomy, and neither the absence of a triangular fibrocartilage complex perforation nor neutral or negative variance contraindicate either. Because of its minimally invasive value proposition and likely success, there are few clinical scenarios for which I do not perform AWP preferentially...
February 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Samir K Trehan, Lindley B Wall, Ryan P Calfee, Tony S Shen, Christopher J Dy, Sarah M Yannascoli, Charles A Goldfarb
PURPOSE: To determine whether the arthroscopic hook and trampoline tests are accurate and reliable diagnostic tests for foveal triangular fibrocartilage complex (TFCC) detachment. METHODS: Wrist arthroscopy was performed on 10 cadaveric upper extremities. Arthroscopic hook and trampoline tests were performed and videos recorded (baseline). The deep foveal TFCC insertion was then sharply detached. Arthroscopic hook and trampoline tests were repeated. Subsequently, the foveal detachment was repaired via an ulnar tunnel technique and the hook test was repeated for a third time...
January 25, 2018: Journal of Hand Surgery
Sebastian Farr, Marion Schüller, Rudolf Ganger, Werner Girsch
Background  To the best of our knowledge, we are not aware of any reports focusing on results of arthroscopic debridement of triangular fibrocartilage complex (TFCC) tears in immature patients. Purpose  The purpose of this study was to evaluate our results after arthroscopic debridement of TFCC tears in adolescents. Materials and Methods  We retrospectively identified all patients of 18 years or less, who received an arthroscopic TFCC debridement due to a traumatic or degenerative tear according to Palmer...
February 2018: Journal of Wrist Surgery
Henrique DE Barros Pinto, Suzilaine Ramos DE Oliveira, Flavia Curvo Pereira, Nilton Mazzer
Objective: This article provides details and tips on the dry arthroscopic technique, based on our experience and its clinical applications. Method: The technique was applied to 65 patients (33 men and 32 women) aged between 20 and 62 years (average of 35.4 years) for treating: synovial cyst resection, scapholunate ligament injury repair, ulnocarpal impact correction, triangular fibrocartilage injury repair, and assisted reduction of distal radius fractures. Results: A minimally invasive intra-articular evaluation has been observed as a benefit, with low infection rate, small scars, and high rates of early recovery, without affecting intra-articular fluid use, reducing the risk of compartment syndrome and infiltrated soft tissues, in the case of need for associated open surgery...
November 2017: Acta Ortopedica Brasileira
Maysara Abdelhalim Bayoumy, Amr El-Sayed, Hesham A Elkady, Waleed Reyad Saleh, Hatem G Said, Abdelaziz M Ali
Triangular fibrocartilage complex (TFCC) injuries are increasingly recognized as a cause of ulnar-sided wrist pain. Palmer grouped these tears into either traumatic or degenerative, with various subclassifications. Magnetic resonance imaging (MRI), arthrogram, and arthroscopy are the methods used to establish the diagnosis. Several arthroscopic methods of TFCC repair including outside-in, inside-out, and all-inside techniques have been described. The outside-in repair, which involves piercing the TFCC via the ulnar side of the wrist, has been described by several authors, but the technique varies among authors with respect to instrumentation and subtle surgical modifications...
October 2017: Arthroscopy Techniques
Jayson C Johnson, Ferris M Pfeiffer, Jill E Jouret, David M Brogan
BACKGROUND: This study compares the effectiveness of a peripheral capsular repair with a knotless arthroscopic transosseous ulnar tunnel repair (TR) in restoring distal radioulnar joint (DRUJ) stability and stiffness in the setting of a massive triangular fibrocartilage complex (TFCC) tear. METHODS: Eight matched pairs of fresh-frozen cadaveric forearms were tested. Each forearm was tested in supination and pronation using 3-dimensional (3D) optical tracking devices prior to any intervention...
January 1, 2018: Hand: Official Journal of the American Association for Hand Surgery
Sun Hwa Lee, Seong Jong Yun
OBJECTIVE: We evaluated the effectiveness of point-of-care wrist ultrasonography compared with 3T-magnetic resonance imaging (MRI) for diagnosing triangular fibrocartilage complex (TFCC) injuries in trauma patients with ulnar-sided pain and instability. Moreover, we assessed the inter-observer variability between an emergency physician and a musculoskeletal radiology fellow. MATERIAL AND METHODS: A prospective cross-sectional study was conducted in an emergency department; patients with ulnar-sided sprain and instability were recruited...
January 4, 2018: American Journal of Emergency Medicine
Hee Jin Park, So Yeon Lee, Kyung A Kang, Eun Young Kim, Hun Kyu Shin, Se Jin Park, Jai Hyung Park, Eugene Kim
OBJECTIVE: To compare image quality of three-dimensional volume isotropic T2-weighted fast spin-echo (3D VISTA) and 2D T2 weighted images (T2WI) for evaluation of triangular fibrocartilage (TFC) and to investigate whether 3D VISTA can replace 2D T2WI in evaluating TFC injury. METHODS: This retrospective study included 69 patients who received wrist MRIs using both 2D T2WI and 3D VISTA techniques for assessment of wrist pathology, including TFC injury. Two radiologists measured the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) of the two sequences...
December 20, 2017: British Journal of Radiology
Won-Taek Oh, Ho-Jung Kang, Yong-Min Chun, Il-Hyun Koh, Hae-Mo-Su An, Yun-Rak Choi
PURPOSE: To compare clinical and radiologic outcomes and complication rates of the arthroscopic wafer procedure (AWP) and ulnar shortening osteotomy (USO) for idiopathic ulnar impaction syndrome (UIS). METHODS: From May 2009 to June 2014, 42 patients who were aged 45 years or older with idiopathic UIS underwent either the AWP or USO under the following identical surgical indications: (1) less than 4 mm of positive ulnar variance, (2) Palmer classification 2C or 2D lesion of the triangular fibrocartilage complex, (3) stable distal radioulnar joint (DRUJ) and/or lunotriquetral joint, and (4) no evidence of osteoarthritis of the DRUJ or ulnocarpal joint...
February 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Ji Hun Park, Dongmin Kim, Jong Woong Park
PURPOSE: Arthroscopic repair of a peripheral triangular fibrocartilage complex (TFCC) tear is a promising, minimally invasive surgical technique, especially in patients with symptomatic distal radioulnar joint (DRUJ) instability. The purpose of this study was to evaluate the clinical result of arthroscopic one-tunnel transosseous foveal repair for peripheral TFCC tears. METHODS: Sixteen patients who underwent TFCC foveal repair were retrospectively evaluated. The mean follow-up period was 31...
November 9, 2017: Archives of Orthopaedic and Trauma Surgery
Steffen Löw, Holger Erne, Ute Strobl, Frank Unglaub, Christian K Spies
Background  Geissler's classification is widely accepted in arthroscopic diagnostics of scapholunate (SL) ligament injury. Thereby, probe insertion into the SL gap from the midcarpal would indicate treatment necessity in patients with SL tear as seen from radiocarpal view. Purpose  In this review, the SL gap width, examined by the probe from midcarpal, was arthroscopically assessed in patients with intact SL ligaments, who were treated for ulnar impaction syndrome. The review examined how often lax SL joints can be found in patients with no complaints with respect to the SL ligaments and in which the SL ligaments were proven to be intact from radiocarpal view...
November 2017: Journal of Wrist Surgery
Jean Jose, Azael Arizpe, Carlos M Barrera, Nisreen Shabbir Ezuddin, David Chen
The triangular fibrocartilage complex (TFCC) is an intricate ligamentous and cartilaginous structure that helps transmit axial load across the wrist, and provide stability to the ulnocarpal and distal radioulnar joints (DRUJ). Because the blood supply to the TFCC varies depending on location, certain types of tears are more amenable to surgical repair than others. Since Palmer proposed his classification system of TFCC tears in 1989, only 1 case of a "bucket-handle" type tear has been reported. In this article, we describe two new cases of bucket-handle tears of the TFCC...
October 27, 2017: Skeletal Radiology
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