How I manage TFCC injuries

نویسنده

  • Toshiyasu Nakamura
چکیده

The TFCC consists of triangular fibrocartilage (TFC), meniscus homologue, ulnolunate ligament, ulnotriquetral ligament, radioulnar ligament, and sheath floor of the extensor carpi ulnaris (ECU). The TFCC functions as a stabilizer of the ulnocarpal and DRU joints, load distributor between ulna and ulnar carpus and introduces smooth forearm rotation. The TFCC is a hammock-like shape supporting and surrounding the ulnar carpus, with the strong and nearly vertical anchor to the ulnar fovea, i.e. the RUL. During forearm rotation, the radius, the carpus and distal surface of the TFCC rotate over the ulnar head, thus simple twisting of the RUL occurs at its foveal attachment. The main stabilizer of this tiny joint is the proximal component of the TFCC, the radioulnar ligament (RUL). Central attaching fibers of the RUL at the fovea indicate isometric pattern during forearm rotation, while eccentric fibers at the fovea and base of the styloid indicate changes in length, dorsal indicates longer length in pronation, while palmar indicates longer in supination. When the RUL is torn, instability of the DRUJ occurs. The greater the tear of the RUL be, the greater instability of the DRUJ indicates. When the RUL is ruptured at the fovea, the RUL must be introduced into the central lesion of the fovea of the ulna. Classical Palmer 1B peripheral lesion also demonstrates moderate DRUJ instability, because this lesion is close to the RUL. Other traumatic lesions on the TFCC, such as Palmer 1A and 1D tear, did not indicate DRUJ instability. Diagnosis of DRUJ instability due to TFCC tear is achieved by physical examination, such as DRUJ ballottement test, arthrogram, MRI and arthroscopy. Image diagnosis is useful, however arthroscopy is a gold standard for diagnosis as well as treatment of the TFCC lesions. DRUJ arthroscopy, recently introduced arthroscopic technique, provides direct visualization of fovea lesion, where the RUL attaches. Treatments of TFCC lesions are depending on the tear site. Palmer 1B lesion is easily treated by arthroscopic capsular repair. Debridement is useful for palmer 1A or 1D tear. We also prefer to shorten the ulna, when there were degenerative changes on the TFC (Palmer Class 2) or with ulnar positive variance. Treatment options for DRUJ instability due to TFCC foveal avulsion are arthroscopic and open repair of the TFCC to the fovea for acute or sub-acute cases and reconstruction of the TFCC using ECU half-slip tendon or PL tendon for chronic TFCC injuries. Ulnar shortening procedure can be useful for partial avulsion of the RUL either dorsal or palmar, but not for complete avulsion of the TFCC at the fovea. Arthroscopic partial resection of the TFCC can no longer indicated for unstable DRUJ, because it does not introduce stabilization of the DRUJ.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Provocative wrist tests and MRI are of limited diagnostic value for suspected wrist ligament injuries: a cross-sectional study.

QUESTION What is the diagnostic value of provocative wrist tests and magnetic resonance imaging (MRI) for suspected wrist ligament injuries? DESIGN Cross-sectional study. PARTICIPANTS 105 people presenting to hand clinics with wrist pain and suspected wrist ligament injuries were evaluated prospectively. OUTCOME MEASURES The integrity of wrist ligaments was tested with seven provocative t...

متن کامل

The Effect of Ligament Injuries on Outcomes of Operatively Treated Distal Radius Fractures.

Various authors have documented wrist ligament injuries in patients with distal radius fractures (DRFs). We conducted a study to determine whether scapholunate interosseous ligament (SLIL), triangular fibrocartilage complex (TFCC), or chondral injuries directly assessed with arthroscopy predict DRF outcomes. Forty-two patients who underwent open reduction and internal fixation of DRFs were enro...

متن کامل

Triangular fibrocartilage complex (TFCC)

ANATOMY The TFCC is a fibrocartilage-ligament complex which stabilizes the distal radioulnar joint (DRUJ), transmits axial load between the carpus and the ulna, and stabilizes the ulnar aspect of the carpus. The TFCC is comprised of the disc proper (articular disc), meniscus homologue, ulnolunate ligament, ulnotriquetral ligament, proximal ligamentous component, volar and dorsal radioulnar liga...

متن کامل

Pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model

BACKGROUND AND PURPOSE Mechanisms of injury to ulnar-sided ligaments (stabilizing the distal radioulnar joint and the ulna to the carpus) associated with dorsally displaced distal radius fractures are poorly described. We investigated the injury patterns in a human cadaver fracture model. METHODS Fresh frozen human cadaver arms were used. A dorsal open-wedge osteotomy was performed in the dis...

متن کامل

High-Resolution 3T MR Imaging of the Triangular Fibrocartilage Complex

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...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره 9  شماره 

صفحات  -

تاریخ انتشار 2015