Styloid Ulna Window Approach for Repair of Avulsed Foveal Attachment of Triangular Fibrocartilage Complex.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 7609631 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1531-6564 (Electronic) Linking ISSN: 03635023 NLM ISO Abbreviation: J Hand Surg Am Subsets: MEDLINE
    • Publication Information:
      Publication: New York : Elsevier
      Original Publication: St. Louis, Mosby.
    • Subject Terms:
      Triangular Fibrocartilage*/surgery ; Triangular Fibrocartilage*/injuries ; Osteotomy*/methods ; Joint Instability*/surgery ; Ulna*/surgery ; Ulna*/diagnostic imaging; Humans ; Male ; Female ; Adult ; Arthroscopy/methods ; Young Adult ; Range of Motion, Articular/physiology ; Wrist Joint/surgery ; Wrist Joint/physiopathology ; Middle Aged ; Retrospective Studies ; Wrist Injuries/surgery ; Wrist Injuries/diagnostic imaging ; Adolescent ; Treatment Outcome ; Hand Strength/physiology
    • Abstract:
      Purpose: To describe a surgical approach for open repair of the triangular fibrocartilage complex foveal avulsion via ulnar styloid osteotomy, and to assess its clinical results.
      Methods: We reviewed 12 patients with distal radioulnar joint (DRUJ) instability due to isolated foveal avulsion of DRUJ ligaments. Wrist arthroscopy was conducted for all patients to exclude the presence of concomitant tear of the superficial part of the triangular fibrocartilage complex and to corroborate the diagnosis with a positive hook test. Through an ulnar approach between flexor and extensor carpi ulnaris, an ulnar styloid osteotomy was performed under image intensifier control just ulnar to the fovea of the head of the ulna. The avulsed foveal attachment was anchored through transosseous sutures passing from the fovea to the neck of the ulna. The ulnar styloid was fixed by means of screws or tension band wires. Outcome measures included clinical assessment of pain (visual analog scale), grip strength, DRUJ instability, range of motion of the wrist, and modified Mayo wrist score. Radiographic assessment was done to determine union of the ulnar styloid osteotomy, DRUJ subluxation, and any hardware-related problems.
      Results: Outcome measures were evaluated after a mean follow-up of 21 months. Healing of the osteotomy was obtained in all cases by 11 weeks. The DRUJ laxity, visual analog scale, and modified Mayo wrist score improved, while grip strength and range of motion remained unchanged. One patient had prominent hardware necessitating removal after union of the osteotomy. There were no reported cases of injury or neuropraxia of the dorsal cutaneous branch of the ulnar nerve.
      Conclusions: Open repair of an avulsed foveal attachment of the triangular fibrocartilage complex using an ulnar styloid osteotomy is an alternative to either open or arthroscopic repair approaches.
      Type of Study/level of Evidence: Therapeutic IV.
      (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: Fovea; TFCC; osteotomy; ulnar styloid; window
    • Publication Date:
      Date Created: 20221113 Date Completed: 20240803 Latest Revision: 20240803
    • Publication Date:
      20240804
    • Accession Number:
      10.1016/j.jhsa.2022.10.010
    • Accession Number:
      36372596