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J Wrist Surg 2016; 05(02): 124-130
DOI: 10.1055/s-0036-1571282
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Stability and Clinical Outcome after Reconstruction of Complete Triangular Fibrocartilage Disruption

Florian Hess
1   Department of Orthopedic and Trauma Surgery, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
,
Reto Sutter
2   Department of Radiology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
,
Ladislav Nagy
3   Department of Orthopedic and Hand Surgery, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
,
Andreas Schweizer
3   Department of Orthopedic and Hand Surgery, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
› Author Affiliations
Further Information

Publication History

18 November 2015

11 December 2015

Publication Date:
15 January 2016 (online)

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Abstract

Purpose Patients with symptomatic instability of the distal radioulnar joint (DRUJ) after traumatic complete disruption of the triangular fibrocartilage complex (TFC) are best treated by anatomic reconstruction of the TFC. Postoperative clinical results from the literature are known but the improvement of DRUJ instability remains still challenging to quantify. We recently published a reliable and validated method to measure the instability of the DRUJ. This sonographic method was used to quantify the pre- and postoperative instability in correlation with clinical outcome in patients with complete TFC disruption.

Methods 11 patients with complete disruption of the TFC resulting in symptomatic instability of the DRUJ underwent open reconstruction of the TFC. The instability was measured with sonography preoperatively and one year postoperatively including the Patient-Rated Wrist Evaluation score (PRWE Score).

Results By subjective measurement, 9 patients showed comparable stability to the contralateral side. By objective measurements, DRUJ stability was completely restored in 6 patients. Seven patients had a very good and good clinical outcome. The dorsovolar shift (preoperative mean 5.2mm, min 2.4, max 7.1; postoperative 3.6mm, min 1.2, max 6.2) was significantly decreased (p < 0.05) and was postoperatively not different to the contralateral healthy side (p > 0.1). PRWE score in the 1 year follow up was 13.8. Three patients remained with significant pain, sonographically two of them were still more lax and one tighter compared to the contralateral side.

Conclusions The sonographic measurement technique allows evaluation of the stability pre- and postoperatively and does not always correlate with the qualitative clinical assessment. The described operation technique is effective for treatment of irreplaceable TFC ruptures and significantly improves the DRUJ stability and wrist function one year after surgery, which could be quantified objectively by ultrasound.

Keywords

TFC lesions - instability - ultrasound
 

  • References

  • 1 Kleinman WB, Graham TJ. The distal radioulnar joint capsule: clinical anatomy and role in posttraumatic limitation of forearm rotation. J Hand Surg Am 1998; 23 (4) 588-599
    CrossrefPubMedGoogle Scholar
  • 2 af Ekenstam F, Hagert CG. Anatomical studies on the geometry and stability of the distal radio ulnar joint. Scand J Plast Reconstr Surg 1985; 19 (1) 17-25
    CrossrefPubMedGoogle Scholar
  • 3 Morrissy RT, Nalebuff EA. Dislocation of the distal radioulnar joint: anatomy and clues to prompt diagnosis. Clin Orthop Relat Res 1979; (144) 154-158
    PubMedGoogle Scholar
  • 4 Kihara H, Short WH, Werner FW, Fortino MD, Palmer AK. The stabilizing mechanism of the distal radioulnar joint during pronation and supination. J Hand Surg Am 1995; 20 (6) 930-936
    CrossrefPubMedGoogle Scholar
  • 5 Nakamura T, Yabe Y, Horiuchi Y. Functional anatomy of the triangular fibrocartilage complex. J Hand Surg [Br] 1996; 21 (5) 581-586
    CrossrefPubMedGoogle Scholar
  • 6 Schuind F, An KN, Berglund L , et al. The distal radioulnar ligaments: a biomechanical study. J Hand Surg Am 1991; 16 (6) 1106-1114
    CrossrefPubMedGoogle Scholar
  • 7 Stuart PR, Berger RA, Linscheid RL, An KN. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg Am 2000; 25 (4) 689-699
    CrossrefPubMedGoogle Scholar
  • 8 Ward LD, Ambrose CG, Masson MV, Levaro F. The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability. J Hand Surg Am 2000; 25 (2) 341-351
    CrossrefPubMedGoogle Scholar
  • 9 Hotchkiss RN, An KN, Sowa DT, Basta S, Weiland AJ. An anatomic and mechanical study of the interosseous membrane of the forearm: pathomechanics of proximal migration of the radius. J Hand Surg Am 1989; 14 (2, Pt 1): 256-261
    CrossrefPubMedGoogle Scholar
  • 10 King GJ, McMurtry RY, Rubenstein JD, Ogston NG. Computerized tomography of the distal radioulnar joint: correlation with ligamentous pathology in a cadaveric model. J Hand Surg Am 1986; 11 (5) 711-717
    CrossrefPubMedGoogle Scholar
  • 11 Pfaeffle HJ, Fischer KJ, Manson TT, Tomaino MM, Woo SL, Herndon JH. Role of the forearm interosseous ligament: is it more than just longitudinal load transfer?. J Hand Surg Am 2000; 25 (4) 683-688
    CrossrefPubMedGoogle Scholar
  • 12 Spinner M, Kaplan EB. Extensor carpi ulnaris. Its relationship to the stability of the distal radio-ulnar joint. Clin Orthop Relat Res 1970; 68 (68) 124-129
    PubMedGoogle Scholar
  • 13 Johnson RK, Shrewsbury MM. The pronator quadratus in motions and in stabilization of the radius and ulna at the distal radioulnar joint. J Hand Surg Am 1976; 1 (3) 205-209
    CrossrefPubMedGoogle Scholar
  • 14 Stuart PR. Pronator quadratus revisited. J Hand Surg [Br] 1996; 21 (6) 714-722
    CrossrefPubMedGoogle Scholar
  • 15 Kleinman WB. Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years. J Hand Surg Am 2007; 32 (7) 1086-1106
    CrossrefPubMedGoogle Scholar
  • 16 Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 2002; 27 (2) 243-251
    CrossrefPubMedGoogle Scholar
  • 17 Breen TF, Jupiter JB. Extensor carpi ulnaris and flexor carpi ulnaris tenodesis of the unstable distal ulna. J Hand Surg Am 1989; 14 (4) 612-617
    CrossrefPubMedGoogle Scholar
  • 18 Hui FC, Linscheid RL. Ulnotriquetral augmentation tenodesis: a reconstructive procedure for dorsal subluxation of the distal radioulnar joint. J Hand Surg Am 1982; 7 (3) 230-236
    CrossrefPubMedGoogle Scholar
  • 19 Tsai TM, Stilwell JH. Repair of chronic subluxation of the distal radioulnar joint (ulnar dorsal) using flexor carpi ulnaris tendon. J Hand Surg [Br] 1984; 9 (3) 289-294
    CrossrefPubMedGoogle Scholar
  • 20 Scheker LR, Belliappa PP, Acosta R, German DS. Reconstruction of the dorsal ligament of the triangular fibrocartilage complex. J Hand Surg [Br] 1994; 19 (3) 310-318
    CrossrefPubMedGoogle Scholar
  • 21 Stein AJ, Adabi K, Schofield JL, Marsh M, Paulo J. Anatomic dorsal and volar radioulnar ligament reconstruction with Mersilene augmentation for distal radioulnar joint instability. Tech Hand Up Extrem Surg 2015; 19 (1) 27-31
    CrossrefPubMedGoogle Scholar
  • 22 Seo KN, Park MJ, Kang HJ. Anatomic reconstruction of the distal radioulnar ligament for posttraumatic distal radioulnar joint instability. Clin Orthop Surg 2009; 1 (3) 138-145
    CrossrefPubMedGoogle Scholar
  • 23 Pürisa H, Sezer İ, Kabakaş F, Tunçer S, Ertürer E, Yazar M. Ligament reconstruction using the Fulkerson-Watson method to treat chronic isolated distal radioulnar joint instability: short-term results. Acta Orthop Traumatol Turc 2011; 45 (3) 168-174
    CrossrefPubMedGoogle Scholar
  • 24 Hess F, Farshad M, Sutter R, Nagy L, Schweizer A. A novel technique for detecting instability of the distal radioulnar joint in complete triangular fibrocartilage complex lesions. J Wrist Surg 2012; 1 (2) 153-158
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (4) 594-606
    CrossrefPubMedGoogle Scholar
  • 26 Shaaban H, Giakas G, Bolton M, Williams R, Scheker LR, Lees VC. The distal radioulnar joint as a load-bearing mechanism—a biomechanical study. J Hand Surg Am 2004; 29 (1) 85-95
    CrossrefPubMedGoogle Scholar
  • 27 Mino DE, Palmer AK, Levinsohn EM. The role of radiography and computerized tomography in the diagnosis of subluxation and dislocation of the distal radioulnar joint. J Hand Surg Am 1983; 8 (1) 23-31
    CrossrefPubMedGoogle Scholar
  • 28 Wechsler RJ, Wehbe MA, Rifkin MD, Edeiken J, Branch HM. Computed tomography diagnosis of distal radioulnar subluxation. Skeletal Radiol 1987; 16 (1) 1-5
    CrossrefPubMedGoogle Scholar
  • 29 Lo IK, MacDermid JC, Bennett JD, Bogoch E, King GJ. The radioulnar ratio: a new method of quantifying distal radioulnar joint subluxation. J Hand Surg Am 2001; 26 (2) 236-243
    CrossrefPubMedGoogle Scholar
  • 30 Bowers WH. The distal radioulnar joint. In: Green DP, Hotschkiss RN, Peterson WC, eds. Green's Operative Hand Surgery. 4th ed. Philadelphia, PA: Churchill Livingstone; 1999: 986-1014
    Google Scholar