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PMID:29068932
Autor:Saito T; Malay S; Chung KC
Endereço:Ann Arbor, Mich.; and Okayama, Japan From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; the Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density, and Pharmaceutical Sciences; and the Department of Surgery, University of Michigan Medical School.
Título:A Systematic Review of Outcomes after Arthroscopic Débridement for Triangular Fibrocartilage Complex Tear.
Fonte:Plast Reconstr Surg; 140(5):697e-708e, 2017 Nov.
ISSN:1529-4242
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Evidence regarding the effectiveness of arthroscopic débridement for a triangular fibrocartilage complex tear is uncertain. The purpose of this study was to conduct a systematic review of outcomes to evaluate the effectiveness of débridement for triangular fibrocartilage complex tears. METHODS: The authors searched all available literature in the PubMed, Embase, and MEDLINE (Ovid) databases for articles reporting on triangular fibrocartilage complex tear débridement. Data collection included arc of motion, grip strength, patient-reported outcomes, and complications. RESULTS: A total of 1723 unique studies were identified, of which 18 studies met the authors' criteria. The mean before and after arc of wrist extension/flexion motion values were 120 and 146 degrees (six studies). The mean before and after grip strength values were 65 percent and 91 percent of the contralateral side (10 studies). Disabilities of the Arm, Shoulder, and Hand scores (six studies) and pain visual analogue scale scores (seven studies) improved from 39 to 18, and from 7 to 3, respectively. The mean pain visual analogue scale score after débridement was 1.9 in the ulnar-positive group and 2.4 in the ulnar-neutral and ulnar-negative groups. Eighty-seven percent of patients returned to their original work. CONCLUSIONS: Patients reported reduced pain and improved functional and patient-reported outcomes after débridement of triangular fibrocartilage complex tears. Most patients after débridement returned to previous work, with few complications. Although some of these cases may require secondary procedures, simple débridement can be performed with suitable satisfactory outcomes for cases with any type of ulnar variance.
Tipo de publicação: JOURNAL ARTICLE; REVIEW


  2 / 311 MEDLINE  
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PMID:28522258
Autor:Nozaki T; Rafijah G; Yang L; Ueno T; Horiuchi S; Hitt D; Yoshioka H
Endereço:Department of Radiological Sciences, University of California, Irvine, CA, USA; Department of Radiology, St Luke's International Hospital, Tokyo, Japan.
Título:High-resolution 3 T MRI of traumatic and degenerative triangular fibrocartilage complex (TFCC) abnormalities using Palmer and Outerbridge classifications.
Fonte:Clin Radiol; 72(10):904.e1-904.e10, 2017 Oct.
ISSN:1365-229X
País de publicação:England
Idioma:eng
Resumo:AIM: To investigate the usefulness of high-resolution 3 T magnetic resonance imaging (MRI) for the evaluation of traumatic and degenerative triangular fibrocartilage complex (TFCC) abnormalities among three groups: patients presenting with wrist pain who were (a) younger than age 50 years or (b) age 50 or older (PT<50 and PT≥50, respectively), and (c) asymptomatic controls who were younger than age 50 years (AC). MATERIALS AND METHODS: High-resolution 3 T MRI was evaluated retrospectively in 96 patients, including 47 PT<50, 38 PT≥50, and 11 AC. Two board-certified radiologists reviewed the MRI images independently. MRI features of TFCC injury were analysed according to the Palmer classification, and cartilage degeneration around the TFCC was evaluated using the Outerbridge classification. Differences in MRI findings among these groups were detected using chi-square test. Cohen's kappa was calculated to assess interobserver and intra-observer reliability. RESULTS: The incidence of Palmer class 1A, 1C and 1D traumatic TFCC injury was significantly (p<0.05) higher in PT≥50 than in PT<50 (class 1A: 47.4% versus 27.7%, class 1C: 31.6% versus 12.8%, and class 1D: 21.1% versus 2.1%). Likewise, MRI findings of TFCC degeneration were observed more frequently in PT≥50 than in PT<50 (p<0.01). Outerbridge grade 2 or higher cartilage degeneration was significantly (p<0.01) more frequently seen in PT≥50 than in PT<50 (55.3% versus 17% in the lunate, 28.9% versus 4.3% in the triquetrum, 73.7% versus 12.8% in the ulna). CONCLUSION: High-resolution wrist MRI at 3 T enables detailed evaluation of TFCC traumatic injury and degenerative changes using the Palmer and Outerbridge classifications, with good or excellent interobserver and intra-observer reliability.
Tipo de publicação: JOURNAL ARTICLE


  3 / 311 MEDLINE  
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PMID:28419031
Autor:Cha SM; Shin HD; Ahn KJ
Endereço:1Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
Título:Prognostic Factors Affecting Union After Ulnar Shortening Osteotomy in Ulnar Impaction Syndrome: A Retrospective Case-Control Study.
Fonte:J Bone Joint Surg Am; 99(8):638-647, 2017 Apr 19.
ISSN:1535-1386
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Ulnar shortening osteotomy (USO) is a widely adopted procedure with excellent outcomes. However, delayed union or nonunion has occasionally been observed. The purpose of this retrospective case-control study was to identify variables affecting osseous consolidation after USO in patients with ulnar impaction syndrome. METHODS: The study included 325 patients who had undergone USO between March 2008 and March 2014. We evaluated the association between union and basic demographic factors as well as preoperative pain (assessed on a visual analog scale [VAS]), range of wrist motion, grip strength, and modified Mayo wrist score. We also assessed the association of union with radiographic variables such as the degree of dorsal subluxation of the ulna, preoperative and postoperative ulnar variance, morphological type of the distal radioulnar joint, gap at the osteotomy site, and presence of newly developed arthritic changes during the follow-up period. Finally, variables associated with operative conditions, such as degeneration of the triangular fibrocartilage complex, use of a parallel double-blade saw, type of plate used for fixation, number of screws, and plate position on the volar or dorsal ulnar surface were investigated. RESULTS: Ulnar union was achieved in 294 patients (group 1), and 31 patients had delayed union or nonunion (group 2). On univariate and multivariate analyses, smoking, low bone mineral density (BMD), a decreased range of motion of the wrist, and use of a double-blade saw were found to be significant factors for an adverse radiographic outcome (nonunion or delayed union). CONCLUSIONS: Delayed union or nonunion occurred in about 10% of patients treated with USO. We suggest that it may be preferable to perform USO in nonsmokers, patients with normal bone density, and those without restricted wrist motion. Also, we recommend the use of a single-blade saw when performing the osteotomy. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Tipo de publicação: JOURNAL ARTICLE


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PMID:28345546
Autor:Zhan HL; Li WT; Bai RJ; Wang NL; Qian ZH; Ye W; Yin YM
Endereço:Department of Radiology, Beijing Jishuitan Hospital, Beijing Institute of Traumatology and Orthopedics, Beijing 100035, China.
Título:High-resolution 3T Magnetic Resonance Imaging of the Triangular Fibrocartilage Complex in Chinese Wrists: Correlation with Cross-sectional Anatomy.
Fonte:Chin Med J (Engl); 130(7):817-822, 2017 Apr 05.
ISSN:0366-6999
País de publicação:China
Idioma:eng
Resumo:BACKGROUND: The injury of the triangular fibrocartilage complex (TFCC) is a common cause of ulnar-sided wrist pain. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) could demonstrate the detailed complex anatomy of TFCC in Chinese. METHODS: Fourteen Chinese cadaveric wrists (from four men and three women; age range at death from 30 to 60 years; mean age at 46 years) and forty healthy Chinese wrists (from 20 healthy volunteers, male/female: 10/10; age range from 21 to 53 years with a mean age of 32 years) in Beijing Jishuitan Hospital from March 2014 to March 2016 were included in this study. All cadavers and volunteers had magnetic resonance (MR) examination of the wrist with coronal T1-weighted and proton density-weighted imaging with fat suppression in three planes, respectively. MR arthrography (MRAr) was performed on one of the cadaveric wrists. Subsequently, all 14 cadaveric wrists were sliced into 2 mm thick slab with band saw (six in coronal plane, four in sagittal plane, and four in axial plane). The MRI features of normal TFCC were analyzed in these specimens and forty healthy wrists. RESULTS: Triangular fibrocartilage, the ulnar collateral ligament, and the meniscal homolog could be best observed on images in coronal plane. The palmar and dorsal radioulnar ligaments were best evaluated in transverse plane. The ulnotriquetral and ulnolunate ligaments were best visualized in sagittal plane. The latter two structures and the volar and dorsal capsules were better demonstrated on MRAr. CONCLUSION: High-resolution 3T MRI is capable to show the detailed complex anatomy of the TFCC and can provide valuable information for the clinical diagnosis in Chinese.
Tipo de publicação: JOURNAL ARTICLE


  5 / 311 MEDLINE  
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PMID:28339356
Autor:Di Matteo A; Filippucci E; Salaffi F; Carotti M; Carboni D; Di Donato E; Grassi W
Endereço:Clinica Reumatologica, "C. Urbani" Hospital, Università Politecnica delle Marche, Jesi, Ancona, Italy. andrea.dimatteo@hotmail.com.
Título:Diagnostic accuracy of musculoskeletal ultrasound and conventional radiography in the assessment of the wrist triangular fibrocartilage complex in patients with definite diagnosis of calcium pyrophosphate dihydrate deposition disease.
Fonte:Clin Exp Rheumatol; 35(4):647-652, 2017 Jul-Aug.
ISSN:0392-856X
País de publicação:Italy
Idioma:eng
Resumo:OBJECTIVES: To compare the diagnostic accuracy of musculoskeletal ultrasound (MSUS) and x-ray in evaluating wrist triangular fibrocartilage complex (TFCC) in patients with calcium pyrophosphate dihydrate deposition disease (CPPD) and to investigate the agreement between the extent of the calcium pyrophosphate dihydrate (CPP) crystal deposits assessed by MSUS and the radiographic findings. METHODS: We enrolled 84 patients: 36 patients with "definite" CPPD and 48 controls. The Ryan and McCarty diagnostic criteria were used. A rheumatologist performed bilateral MSUS examinations of the TFCC in all patients, assessing both the presence and absence of CCP crystals deposits and their extent (0-3; 0: absent; 1: 1-2 spots; 2: more than two spots covering <50% of the volume of the structure; 3: deposits covering >50% of the volume of the structure). A radiologist evaluated the presence/absence of x-ray calcifications at TFCC level in both groups. RESULTS: MSUS and x-ray sensitivity was 77.8% and 76.4%, respectively, whereas MSUS and x-ray specificity was 90.6% and 96.9%, respectively. Total agreement between MSUS and radiographic findings indicative of calcifications at TFCC level was 88.7%. CONCLUSIONS: This study supports the diagnostic accuracy of MSUS and x-ray in evaluating TFCC crystal deposits in patients with CPPD. Sensitivity and specificity of MSUS and x-ray resulted comparable. The highest MSUS score of the extent of the deposits correlated better with x-ray findings.
Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE


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PMID:28246600
Autor:Hammer N; Hirschfeld U; Strunz H; Werner M; Wolfskämpf T; Löffler S
Endereço:Department of Anatomy, University of Otago, Dunedin, New Zealand; Department of Anatomy, University of Leipzig, Leipzig, Germany.
Título:Can the Diagnostics of Triangular Fibrocartilage Complex Lesions Be Improved by MRI-Based Soft-Tissue Reconstruction? An Imaging-Based Workup and Case Presentation.
Fonte:Biomed Res Int; 2017:5870875, 2017.
ISSN:2314-6141
País de publicação:United States
Idioma:eng
Resumo:. The triangular fibrocartilage complex (TFCC) provides both mobility and stability of the radiocarpal joint. TFCC lesions are difficult to diagnose due to the complex anatomy. The standard treatment for TFCC lesions is arthroscopy, posing surgery-related risks onto the patients. This feasibility study aimed at developing a workup for soft-tissue reconstruction using clinical imaging, to verify these results in retrospective patient data. . Microcomputed tomography ( -CT), 3 T magnetic resonance imaging (MRI), and plastination were used to visualize the TFCC in cadaveric specimens applying segmentation-based 3D reconstruction. This approach further trialed the MRI dataset of a patient with minor radiological TFCC alterations but persistent pain. . TFCC reconstruction was impossible using -CT only but feasible using MRI, resulting in an appreciation of its substructures, as seen in the plastinates. Applying this approach allowed for visualizing a Palmer 2C lesion in a patient, confirming ex postum the arthroscopy findings, being markedly different from MRI (Palmer 1B). . This preliminary study showed that image-based TFCC reconstruction may help to identify pathologies invisible in standard MRI. The combined approach of -CT, MRI, and plastination allowed for a three-dimensional appreciation of the TFCC. Image quality and time expenditure limit the approach's usefulness as a diagnostic tool.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  7 / 311 MEDLINE  
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PMID:28034486
Autor:Ma CH; Lin TS; Wu CH; Li DY; Yang SC; Tu YK
Endereço:Department of Orthopedics, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
Título:Biomechanical Comparison of Open and Arthroscopic Transosseous Repair of Triangular Fibrocartilage Complex Foveal Tears: A Cadaveric Study.
Fonte:Arthroscopy; 33(2):297-304, 2017 Feb.
ISSN:1526-3231
País de publicação:United States
Idioma:eng
Resumo:PURPOSE: To biomechanically compare the stability between open repair and arthroscopic transosseous repair technique for reattachment of the foveal triangular fibrocartilage complex (TFCC). We also evaluated the feasibility of a new aiming device for the creation of 2 bone tunnels simultaneously during the arthroscopic technique. METHODS: Six matched pairs of fresh-frozen forearm cadaver specimens were prepared for testing. Group I specimens were treated by open repair with suture anchor. Group II specimens were treated by arthroscopic transosseous suture with a new aiming device. Before and after disruption of the TFCC fovea and after its repair, dorsal and palmar translation of the ulna was measured in both groups in response to a load (3 kg) applied in the palmar and then in the dorsal direction. The total translation of the ulna was calculated as the sum of the mean dorsal and palmar translations. RESULTS: The mean total ulnar translation before and after TFCC disruption, and after TFCC repair was 5.94 ± 2.16 mm, 9.08 ± 2.64 mm, and 6.04 ± 2.18 mm, respectively. The specimens demonstrated a significant increase in the total translation of the ulna after disruption of the ulnar attachment of TFCC (P = .003), whereas a significant decrease was observed after TFCC foveal repair (P = .003). The median percentage of eliminated translation after TFCC repair was 64% and 172%, respectively, in groups I and II (P = .043). CONCLUSIONS: The athroscopic transosseous suture technique demonstrated superior repair efficacy to the open repair technique in terms of biomechanical strength. This cadaveric study also demonstrated the feasibility of a new aiming device. CLINICAL RELEVANCE: When making decisions about TFCC foveal repair, arthroscopic transosseous suture technique may provide better biomechanical strength than the open repair technique.
Tipo de publicação: JOURNAL ARTICLE


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PMID:27535592
Autor:von Borstel D; Wang M; Small K; Nozaki T; Yoshioka H
Endereço:Department of Radiological Sciences, University of California.
Título:High-Resolution 3T MR Imaging of the Triangular Fibrocartilage Complex.
Fonte:Magn Reson Med Sci; 16(1):3-15, 2017 Jan 10.
ISSN:1880-2206
País de publicação:Japan
Idioma:eng
Resumo: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 wrist protocol, there are specific techniques used to optimize 3T imaging of the wrist; including driven equilibrium sequence (DRIVE), parallel imaging, and 3D imaging. The coil choice for 3T imaging of the wrist depends on a number of variables, and the proper coil design selection is critical for high-resolution wrist imaging with high signal and contrast-to-noise ratio. The TFCC is a complex structure and is composed of the articular disc (disc proper), the triangular ligament, the dorsal and volar radioulnar ligaments, the meniscus homologue, the ulnar collateral ligament (UCL), the extensor carpi ulnaris (ECU) tendon sheath, and the ulnolunate and ulnotriquetral ligaments. The Palmer classification categorizes TFCC lesions as traumatic (type 1) or degenerative (type 2). In this review article, we present clinical high-resolution MR images of normal TFCC anatomy and TFCC injuries with this classification system.
Tipo de publicação: JOURNAL ARTICLE; REVIEW


  9 / 311 MEDLINE  
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PMID:27663055
Autor:Huber M; Loibl M; Eder C; Kujat R; Nerlich M; Gehmert S
Endereço:Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany. Electronic address: michaela1.huber@klinik.uni-regensburg.de.
Título:Effects on the Distal Radioulnar Joint of Ablation of Triangular Fibrocartilage Complex Tears With Radiofrequency Energy.
Fonte:J Hand Surg Am; 41(11):1080-1086, 2016 Nov.
ISSN:1531-6564
País de publicação:United States
Idioma:eng
Resumo:PURPOSE: This cadaver study investigated the temperature profile in the wrist joint and distal radioulnar joint (DRUJ) during radiofrequency energy (RFE) application for triangular fibrocartilage complex resection. METHODS: An arthroscopic partial resection of the triangular fibrocartilage complex using monopolar and bipolar RFE was simulated in 14 cadaver limbs. The temperature was recorded simultaneously in the DRUJ and at 6 other anatomic locations of the wrist during RFE application. RESULTS: The mean temperature in the DRUJ was 43.3 ± 8.2°C for the bipolar system in the ablation mode (60 W) and 30.4 ± 3.4°C for the monopolar system in the cut mode (20 W) after 30 seconds. The highest measured temperature in the DRUJ was 54.3°C for the bipolar system and 68.1°C for the monopolar system. CONCLUSIONS: The application of RFE for debridement or resection of the triangular fibrocartilage complex in a clinical setting can induce peak temperatures that might cause damage to the cartilage of the DRUJ. Bipolar systems produce higher mean temperatures than monopolar devices. CLINICAL RELEVANCE: RFE application increases the mean temperature in the DRUJ after 30 seconds to a level that may jeopardize cartilage tissue.
Tipo de publicação: JOURNAL ARTICLE


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PMID:27653142
Autor:Ruchelsman DE; Vitale MA
Endereço:Division of Hand Surgery, Newton-Wellesley Hospital, Department of Orthopaedic Surgery, Tufts University School of Medicine, Hand Surgery Research and Education Foundation, Newton, MA. Electronic address: druchelsman@partners.org.
Título:Extensor Carpi Ulnaris Subsheath Reconstruction.
Fonte:J Hand Surg Am; 41(11):e433-e439, 2016 Nov.
ISSN:1531-6564
País de publicação:United States
Idioma:eng
Resumo:Acute extensor carpi ulnaris (ECU) subsheath injury and chronic subsheath insufficiency may result in symptomatic ECU instability at the level of the distal ulna osseous sulcus. Associated ulnocarpal (ie, triangular fibrocartilage complex) and ECU intrinsic tendinopathic changes may accompany subsheath pathologies and require concomitant treatment. Surgical treatment is indicated in refractory cases despite nonoperative treatment and may consist of repair of the torn edge of the ECU subsheath or, more frequently, reconstruction utilizing a radially based extensor retinacular sling. An ECU subsheath reconstructive technique is detailed.
Tipo de publicação: JOURNAL ARTICLE; REVIEW



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