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PubMed1995

Low field MRI and scaphoid fracture.

18 consecutive patients suspected of and treated for an acute scaphoid fracture were examined by lowfield MRI. This showed 11 fractures while seven scaphoids were considered normal. T1 weighted images showed a fracture as an area of decreased signal intensity. Two radiologically obvious fractures produced normal MR images. These fractures proved to be the result of old trauma. A wide spectrum of additional traumatic lesions in the wrists, not detected by routine X-ray analysis, were also demonstrated. These included seven fragmented triangular fibrocartilages (TFC), torn scapho-lunate ligaments in four cases and one torn triquetro-lunate ligament. Bone bruises of other carpal bones and seven other carpal fractures were also detected. Low field MRI can be used to show scaphoid fractures and allows diagnosis of additional or simulating lesions.

Adolescent↗
PubMed1996

The role of dynamic magnetic resonance imaging in the detection of lesions of the ulnocarpal complex.

A prospective study of 32 patients was carried out to investigate the significance of dynamic magnetic resonance imaging (MRI) in diagnosis of triangular fibrocartilage (TFC) lesions. Tears of the TFC can be diagnosed well by means of static MRI and arthroscopy. Dynamic MRI examination has an advantage in evaluating the stability of the TFC and ulnocarpal impingement. By means of dynamic MRI it was possible to make a preoperative diagnosis of an ulnocarpal impingement in five patients, a diagnosis which was confirmed through arthroscopy in all cases. In three further patients, dynamic MRI showed ulnocarpal impingement caused by instability of the ulnar attachment of the TFC. This kind of impingement could not be ascertained arthroscopically. Dynamic MRI extends the possibilities of evaluating obscure ulnar wrist pain. Its significance lies in the non-invasive examination of ulnocarpal impingement as well as the evaluation of TFC stability.

Adolescent↗
PubMed1996

The role of arthroscopy in the investigation of wrist disorders.

The findings at arthroscopy of the wrist in 48 consecutive cases carried out over a 4.5 year period have been retrospectively reviewed. In correlating the clinical and arthroscopic findings in the 36 patients with wrist instability and triangular fibrocartilage injuries we found concurrence in 28 of the cases. In the six patients in whom we were unable to make any provisional clinical diagnosis we did not find arthroscopy helpful. Arthroscopy usefully influenced the management in two of the six patients in whom the articular surface was assessed. We feel that a careful clinical examination of the wrist is the mainstay of diagnosis in wrist disorders. Arthroscopy remains useful in selected cases but has a limited specialized role which should continue to be provided from specialist centres.

Adolescent↗
PubMed1996

The Galeazzi-equivalent lesion in children revisited.

A fracture at the medial end of the distal third of the radius with an epiphyseal separation of the distal ulna in a 16-year-old boy is described. This injury, known as the Galeazzi-equivalent lesion in children, is characterized by complete distal ulnar epiphyseal separation without rupture of the distal ligamentous stabilizing system between the radius and ulna, which includes the triangular fibrocartilage complex, interosseous ligaments and periosteal tube of the ulnar. The Galeazzi fracture-dislocation and the Galeazzi-equivalent lesion appear to be completely dissimilar in their pathological anatomy. We suggest calling the latter a "pseudo-Galeazzi injury".

Adolescent↗
PubMed1996

A two-dimensional kinematic analysis of the distal radioulnar joint.

The triangular fibrocartilage and its function in the kinematics of pronation and supination in the distal radioulnar joint was studied. Measurements of the constituent parts of this joint in 11 cadavers showed that the palmar radioulnar ligament is at least 2 mm longer than the dorsal radioulnar ligament. Based on these measurements the movements of the joint were modelled in a two-dimensional kinematic chain. Predictions based on this chain could be confirmed by direct observation and videotaping dissections of joints of unfixed specimens and three-dimensional reconstructions of a CT scan of a healthy volunteer. It could be concluded that (a) the dorsal part is tight during pronation and the palmar part during supination and (b) considerable asymmetrical translations, (dorsal translation being the largest) occur because of the length differences of the ligaments.

Biomechanical Phenomena↗
PubMed1997

Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients.

We examined the frequency of associated chondral and ligament lesions in distal fractures of the radius in young adults (men 20-60 years, women 20-50 years). Fifty initially displaced fractures were examined arthroscopically. Chondral lesions were found in 16 patients (32%). All patients but one were found to have a ligamentous injury in the wrist. No major instability was found. The most frequent ligament tear was the triangular fibrocartilage complex in 39 cases (78%), with a statistical correlation to ulnar styloid fractures. The scapholunate ligament was partially or totally torn in 27 cases (54%). No correlation was found between specific fracture type and pattern of ligament injury. Chondral and ligamentous lesions were frequent and may explain poor outcomes after seemingly well-healed distal fractures of the radius. The ligament lesions should also be kept in mind when early mobilization of the distal fracture of the radius is considered.

Adult↗
PubMed1997

Subcutaneous extensor tendon rupture associated with calcium pyrophosphate dihydrate crystal deposition disease of the wrist.

We report a patient with rupture of the ring extensor tendon associated with calcium pyrophosphate dihydrate crystal deposition disease of the wrist. Crystal deposits were noted in synovium and the triangular fibrocartilage complex. Histological examination revealed chronic synovitis with foreign body giant cell reaction to crystals. The cause of the tendon rupture was synovitis due to crystal deposition.

Aged↗
PubMed1997

The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain.

Forty-five patients with persistent ulnar-sided wrist pain and a positive ulnocarpal stress test were investigated by X-ray, arthrography, 99mTechnetium bone scanning, magnetic resonance imaging and wrist arthroscopy. Ulnar wrist pathology was positively identified in nine of 45 patients by X-ray, 18 of 37 by arthrography, 19 of 27 by bone scan, four of 33 by MRI, and in all 45 patients by arthroscopy. The final diagnosis was ulnocarpal abutment syndrome in 28 patients, traumatic triangular fibrocartilage (TFC) tear in six, lunotriquetral (LT) ligament tear in five, TFC and LT ligament tear in one, wrist arthritis in four and cartilaginous free body in one. The ulnocarpal stress test is a useful provocative test, and a positive test suggests the presence of ulnar-sided wrist pathology. The test is sufficiently sensitive to warrant further investigation by arthroscopy.

Adolescent↗
PubMed1998

Avulsion fracture at the fovea of the ulna. A report of two cases.

We report two cases of avulsion fractures at the fovea of the ulna. This injury is caused by a strong distraction force which avulses the insertion of the triangular ligament at the fovea of the ulna. This injury can be classed as an injury to the triangular fibrocartilage complex.

Adult↗
PubMed1998

The role of arthroscopy in the treatment of wrist injuries in the athlete.

Wrist arthroscopy provides an ideal means of evaluating intraarticular soft-tissue injuries of the wrist. Many lesions such as tears of the triangular fibrocartilage complex can be treated by arthroscopic means as well. Reduction of articular fractures of the distal radius and pin fixation, reduction of scaphoid fractures and intramedullary fixation, and arthroscopic reduction and transcutaneous pin stabilization of acute carpal dissociation patterns can all be accomplished with minimally invasive techniques under arthroscopic control. These measures often provide the athlete with shorter periods of immobilization and earlier return to athletic competition. Wrist arthroscopy provides a very useful adjunct to the treatment armamentarium of all sports medicine physicians.

Arthroscopy↗
PubMed2001

Arthroscopic capsulodesis of the lunotriquetral joint.

A case series consisting of 20 consecutive patients with persistent ulnar-sided mechanical wrist pain, lunotriquetral interosseous (LTIOL) ligament tears resulting in joint incongruity and increased laxity, and traumatic triangular fibrocartilage complex (TFCC) tears was reviewed. Each patient underwent an arthroscopic reduction and internal fixation (ARIF) of the lunotriquetral joint, arthroscopic disk-carpal (disklunate-ulnocapitate-disktriquetral, DL-UC-DT) ligament plication, and TFCC repair or débridement. There were 12 right wrists and 8 left wrists, of which 12 were dominant. The mean patient age was 33 years; 7 patients had workers' compensation claims and 2 had legal claims. Fourteen patients recalled a specific injury mechanism, such as hyperextension or rotation. The accompanying traumatic TFCC tears were peripheral in 15 and linear radial in 6 patients (one patient had concomitant peripheral and radial linear tears), and in 6 cases, the palmar ulnocarpal extrinsic ligaments were partially torn. The mean preoperative modified Mayo Wrist Score was 50, and at a mean of 3.1 years after surgery, the score had increased to 88. There were 13 excellent, 5 good, and 2 fair results. Four patients had complications, including transient tenderness along the extensor carpi ulnaris and persistent neuritis of a dorsal branch of the ulnar nerve. Overall wrist comfort and function, as indicated by the modified Mayo Wrist Scores, improved after arthroscopic stabilization of ulnar-sided wrist injuries (pinning of the lunotriquetral joint, disk-carpal ligament plication, and TFCC repair or débridement).

Adult↗
PubMed2003

Kinematic and torque-related effects of dorsally angulated distal radius fractures and the distal radial ulnar joint.

PURPOSE: The purpose of this study was to examine the torque required to achieve a full range of motion of the distal radioulnar joint (DRUJ) as a result of increasing dorsal angulation from simulated fractures of the distal radius. Based on this study the accepted amount of dorsal angulation of the distal radius can be determined. METHODS: In 9 fresh cadaver limbs motion of the DRUJ was simulated by a custom motion and loading forearm device. The malunion model of the distal radius was controlled by a specially designed external fixation frame that provided control in 6 degrees of dorsal angulations (N, 0 degrees, 10 degrees, 20 degrees, 30 degrees, and 40 degrees ). The study included an intact and nonintact triangular fibrocartilage complex. RESULTS: This study showed that torque across the DRUJ was affected by the degree of simulated malunion of the distal radius. With more than 30 degrees dorsal angulation the torque across the DRUJ was increased in both muscle loading and unloading conditions. Although significance was not noted, with resistive loading this study showed torque changes with as little as 10 degrees malunion of the distal radius. CONCLUSIONS: We conclude that reduction of distal radius fractures to within 10 degrees of dorsal angulation is needed to allow patients to maintain full forearm and wrist rotation.

Aged↗
PubMed1983

Arthrography of the wrist.

Eighty-four wrist arthrograms were performed on 76 patients with posttraumatic wrist pain. Instillation of a small amount of contrast media into the radiocarpal joint under fluoroscopic control was helpful in delineating specific areas of pathology about the wrist. Comparison of the arthrographic findings with the plane films of 74 patients and the operative findings of 24 patients revealed that the arthrogram was most helpful in delineating perforations of the scapholunate ligament, the lunotriquetral ligament, the triangular fibrocartilage complex, and the wrist joint capsule.

Adolescent↗
PubMed1985

Radiolunate arthrodesis.

The procedure of radiolunate arthrodesis was suggested by spontaneous radiolunate arthrodesis that resulted in painless, satisfactory function. Ulnar translation down the inclined slope of the radius is accelerated by dorsal dislocation of the ulnar head, ulna minus variance, and triangular fibrocartilage resorption and may be an inducement to increased ulnar deviation of the fingers as well as disintegration of the proximal carpal row. Twenty-two radiolunate arthrodeses were performed, 16 by a corticocancellous slotted graft and six by a modified Lauenstein procedure in 17 rheumatoid and five traumatic cases. Nineteen wrists were available for follow-up at an average of 28 months. Average range of motion was 25 degrees of extension, 30 degrees of flexion, 5 degrees of radial deviation, and 15 degrees of ulnar deviation. Subjective evaluation was good in 14 wrist, fair in three, and poor in two. Relief of pain was generally satisfactory, and preoperative grip strength was slightly improved. Progressive degeneration of the midcarpal joint tends to be minimal. If further spontaneous arthrodesis occurs, the wrist remains in satisfactory position. Carpal ulnar translation, midcarpal angulation, and radial angulation are corrected. Loss of carpal height is partially corrected in most instances.

Adolescent↗
PubMed1986

Computerized tomography of the distal radioulnar joint: correlation with ligamentous pathology in a cadaveric model.

The kinematics of the normal distal radioulnar joint (DRUJ) and the stabilizing function of various structures about the DRUJ were investigated in a study involving six fresh frozen cadavers. Sequential division of the supporting structures was correlated with abnormalities detected by computerized tomography (CT). The infratendinous portion of the extensor carpi ulnaris is a major restraint against dorsal and palmar subluxation. Division of the radioulnar ligaments and triangular fibrocartilage alone produced only minor changes. Lateral displacement was controlled by the interosseous membrane and the pronator quadratus. CT is a useful method of gaining objective and quantifiable information regarding incongruity of the DRUJ. Three scans--one each in pronation, neutral, and supination--would be optimal. The pronation scan is likely to detect palmar subluxation, while the neutral scan is sensitive for dorsal subluxation and DRUJ diastasis. The supination view should confirm reduction of any subluxation. An important observation of this study was the spontaneous reduction of palmar, dorsal, and lateral displacement in supination. This suggests that immobilization in supination may be indicated in cases of acute DRUJ injury.

Cadaver↗
PubMed1986

Matched distal ulnar resection.

Painful disorders of the distal radioulnar joint severely limit the work capability of the hand. Until recently, the standard treatment for this problem has been transverse resection of the distal ulna, as originally proposed by Darrach. A technique for a "matched" resection arthroplasty of the distal ulna, leaving the ulnar shaft--styloid axis along with the triangular fibrocartilage complex and the distal ulnar ligamentous attachments intact, has been used since 1967. This procedure resects the distal ulna in a long, smooth, convex curve, matching the opposing surface of the concave radial metaphysis in three dimensions. Forty-four wrists were followed for an average of 6.5 years and showed that the procedure is reliable and relieves pain while retaining a more normal ulnocarpal, radioulnar, and radiocarpal alignment, with painless pronation averaging 80.5 degrees and supination of 88.5 degrees.

Adolescent↗
PubMed1987

Dorsal dislocation of the ulnar styloid and extensor carpi ulnaris tendon into the distal radioulnar joint: the empty sulcus sign.

Two cases of distal radioulnar joint (DRUJ) disruption and diastasis secondary to distal radial fractures were associated with displacement of the ulnar styloid and extensor carpi ulnaris (ECU) into the DRUJ. Both cases had a palpable empty ECU tendon sulcus. In one case surgical exploration revealed that the ulnar styloid, triangular fibrocartilage, and extensor carpi ulnaris tendon had dislocated into the DRUJ as a unit. The end result was good. In the second case lack of recognition and reduction of the ECU tendon and ulnar styloid led to persistent subluxation and diastasis. The end result was poor. Early recognition of the dislocation of the ulnar and ECU into the DRUJ and their significance may avoid poor results.

Aged↗