BACKGROUND: Triangular fibrocartilage complex (TFCC) injuries, especially Palmer type IB, pose surgical management challenges due to associated distal radial ulnar joint (DRUJ) instability. Traditional surgeries entail risks of complications. Arthroscopic repair presents advantages but lacks consensus on optimal techniques. To evaluate arthroscopic dual-bone tunnel repair in patients with Palmer type IB TFCC injuries of the wrist.
METHODS: In this retrospective case series, grip strength ratio, joint range of motion, pain visual analogue scale (VAS), modified Mayo wrist score, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were assessed before and 12 months after surgery.
RESULTS: The cohort consisted of 45 patients. At 12 months, the grip strength ratio improved from 0.71 ± 0.08 to 0.93 ± 0.05 (P < 0.001), and wrist joint rotation increased from 126.78 ± 13.28° to 145.76 ± 8.52° (P < 0.001). VAS (1.60 ± 0.58 vs. 6.33 ± 0.91, P < 0.001), DASH (12.96 ± 3.18 vs. 46.87 ± 6.62, P < 0.001), and modified Mayo wrist (88.11 ± 4.43 vs. 63.78 ± 7.99, P < 0.001) scores all improved after surgery. The overall complication rate was 4.44%.
CONCLUSIONS: Arthroscopic dual-bone tunnel repair appears to be an effective intervention for alleviating wrist pain, restoring stability, and enhancing joint function in patients with TFCC Palmer type IB injuries.

UNASSIGNED: To compare the short-term effectiveness of arthroscopic suture of triangular fibrocartilage complex (TFCC), arthroscopic suture of TFCC combined with open reduction and internal fixation, and simple open reduction and internal fixation in the treatment of distal radius fractures combined with ulnar styloid base fractures and TFCC injury.
UNASSIGNED: A clinical data of 97 patients with distal radius fractures combined with ulnar styloid base fracture and TFCC injury, who were admitted between September 2019 and September 2022 and met the selective criteria, was retrospectively analyzed. After reduction and internal fixation of distal radius fractures, 37 cases underwent arthroscopic suture of TFCC (TFCC group), 31 cases underwent arthroscopic suture of TFCC combined with open reduction and internal fixation of ulnar styloid base fractures (combination group), and 29 cases underwent simple open reduction and internal fixation of ulnar styloid base fractures (internal fixation group). There was no significant difference in baseline data between groups ( P>0.05), such as gender, age, injury side, time from injury to operation, and preoperative radius height, palm inclination, ulnar deviation, grip strength, wrist range of motion (ROM) in rotation, ulnar-radial deviation, and flexion-extension. The differences (change value) in radius height, metacarpal inclination angle, ulnar deviation angle, grip strength, and wrist ROM in rotation, ulnar-radial deviation, and flexion-extension between preoperative and 12 months after operation in 3 groups were compared. The effectiveness was evaluated according to the modified Gartland-Werley score at 12 months after operation.
UNASSIGNED: All incisions healed by first intention. All patients were followed up 12-18 months (mean, 14 months). X-ray films showed that there were 4 patients with non-union of ulnar styloid base fracture in TFCC group, and the remaining patients had fracture healing at 3 months after operation. The radius height, palm inclination, and ulnar deviation of 3 groups at 12 months after operation were significantly better than those before operation ( P<0.05); however, the differences in the change values of the above indexes between groups was not significant ( P>0.05). At 12 months after operation, the change values of wrist ROM in rotation, ulnar-radial deviation, and flexion-extension in the TFCC group and the combination group were significantly greater than those in the internal fixation group ( P<0.05), and there was no significant difference between the TFCC group and the combination group ( P>0.05). The change values of grip strength was significantly greater in the combination group than in the internal fixation group ( P<0.05); there was no significant difference between the other groups ( P>0.05). The excellent and good rates according to the modified Gartland-Werley score were 91.89% (34/37), 93.54% (29/31), and 72.41% (21/29) in the TFCC group, the combination group, and the internal fixation group, respectively. The excellent and good rates of the TFCC group and the combination group were significantly higher than that of the internal fixation group ( P<0.05); there was no significant difference between the TFCC group and the combination group ( P>0.05).
UNASSIGNED: For ulnar styloid base fractures with TFCC injury, compared with simple open reduction and internal fixation, arthroscopic suture of TFCC or suture TFCC combined with internal fixation treatment are both beneficial for wrist function recovery, and their short-term effectiveness are similar. Therefore, arthroscopic suture of TFCC may be a better choice.
UNASSIGNED: 比较单纯关节镜下缝合三角纤维软骨复合体（triangular fibrocartilage complex，TFCC）、缝合TFCC联合切开复位内固定与单纯切开复位内固定尺骨茎突骨折治疗桡骨远端骨折合并尺骨茎突基底部骨折伴TFCC损伤的近期疗效。.
UNASSIGNED: 回顾性分析2019年9月—2022年9月收治且符合标准的97例桡骨远端骨折合并尺骨茎突基底部骨折并伴TFCC损伤患者临床资料。桡骨远端骨折复位内固定后，37例单纯关节镜下缝合TFCC（TFCC组）、31例缝合TFCC联合切开复位内固定尺骨茎突骨折（联合组）、29例单纯切开复位内固定尺骨茎突骨折（内固定组）。3组患者性别、年龄、受伤侧别、受伤至手术时间以及术前桡骨高度、掌倾角、尺偏角、握力、腕关节旋转活动度、尺桡偏活动度、屈伸活动度等基线资料比较，差异均无统计学意义（ P>0.05）。比较3组患者术前及术后12个月桡骨高度、掌倾角、尺偏角，腕关节旋转活动度、尺桡偏活动度、屈伸活动度及握力差值（变化值），术后12个月采用改良Gartland-Werley评分评价疗效。.
UNASSIGNED: 术后切口均Ⅰ期愈合。患者均获随访，随访时间12～18个月，平均14个月。X线片复查示，TFCC组4例尺骨茎突骨折不愈合，其余患者术后3个月时骨折均愈合；术后12个月3组桡骨高度、掌倾角、尺偏角均优于术前（ P<0.05），但上述指标变化值组间差异均无统计学意义（ P>0.05）。术后12个月，TFCC组、联合组腕关节旋转、尺桡偏、屈伸活动度变化值均优于内固定组（ P<0.05），TFCC组与联合组间差异无统计学意义（ P>0.05）。联合组握力变化值优于内固定组，差异有统计学意义（ P<0.05）；其余组间差异均无统计学意义（ P>0.05）。TFCC组、联合组、内固定组腕关节改良Gartland-Werley评分优良率分别为91.89%（34/37）、93.54%（29/31）、72.41%（21/29）；TFCC组、联合组优良率高于内固定组，差异有统计学意义（ P<0.05）；TFCC组与联合组间差异无统计学意义（ P>0.05）。.
UNASSIGNED: 对于合并TFCC损伤的尺骨茎突基底部骨折，与单纯切开复位内固定相比，关节镜下单纯缝合修复TFCC或联合内固定治疗均有利于术后早期腕关节功能恢复，且两者疗效相似，因此关节镜下单纯修复缝合TFCC可能是更好选择。.

The feasibility and accuracy of robot-assisted bone tunnel construction in the transosseous repair of the triangular fibrocartilaginous complex (TFCC) were compared with those of freehand arthroscopic repair. A total of 20 cadaveric specimens were randomized into robotic-assisted and arthroscopy-guided groups. Three bone tunnels were constructed in the ulnar foveal region in each specimen. The discrepancy between the planned and actual tunnel exits was determined in the robot-assisted group by merging images. The success rate of tunnel construction, time consumption and number of drilling attempts were compared between groups. The median planned/actual exit discrepancy was 0.8 mm in the robot-assisted group, with 90% of tunnel exits successfully placed in the footprint region, compared to 63.3% in the arthroscopy-guided group. The robot-assisted group spent less time and required fewer drilling attempts to construct bone tunnels. These results indicated that the robot-assisted technique can accurately construct multiple bone tunnels in the foveal region and reduce the difficulty of TFCC transosseous repair.Level of evidence: III.

OBJECTIVE: Wrist arthroscopy is considered the gold standard for diagnosis of intra-articular wrist conditions including triangular fibrocartilage complex (TFCC) tears; however, the ability to reliably diagnose TFCC pathology during wrist arthroscopy is unclear. The purpose of this study was to assess the reliability of the diagnosis of TFCC tears on wrist arthroscopy videos.
METHODS: Five hand surgeons reviewed 43 cases on a secure web-based platform at two time points separated by 4-6 weeks. Each case included a deidentified clinical vignette and wrist radiographs with ulnar variance measurements and an arthroscopy video of ulnar wrist pathology, averaging 42 seconds. Surgeons were queried on the presence of TFCC tear and Palmer and Atzei classifications. Interobserver/intraobserver reliabilities were determined using kappa coefficients.
RESULTS: The interobserver reliability regarding the presence/absence of TFCC tear was fair-good, with kappa coefficients of 0.596 in the first round of case review and 0.708 in the second round. The overall intraobserver reliability for the presence/absence of TFCC tear was also fair-good, with a kappa coefficient of 0.567. For cases with central TFCC tears, the interobserver reliability regarding the presence of TFCC tear was perfect, with a kappa coefficient of 1.0. When central tears were excluded, the kappa coefficients decreased to 0.322 and 0.368 in each round. The interobserver reliability for the Palmer and Atzei classifications was low, with kappa coefficients of 0.220 and 0.121 in the first round and 0.222 and 0.123 in the second round.
CONCLUSIONS: Experienced wrist arthroscopy surgeons demonstrated fair-good interobserver reliability for the diagnosis of TFCC tear on wrist arthroscopy. However, when central TFCC tears were excluded, interobserver reliability was poor. These findings demonstrate a need for a focus on education for wrist arthroscopy anatomy.
CONCLUSIONS: This investigation demonstrated poor agreement in surgeon identification and classification of TFCC tears, aside from central TFCC tears. The low reliability has a direct bearing on treatment considerations for TFCC tears.

UNASSIGNED: The forearm connects the wrist and elbow joints, and its stability depends on the two articulations, the proximal and distal radioulnar joints, and the interosseous membrane complex. The aim of this case report is to present an acute case of longitudinal radioulnar dissociation with humeral capitellum fracture.
UNASSIGNED: A 48-year-old man suffered longitudinal radioulnar dissociation with humeral capitellar fracture following a motorcycle accident. Surgical treatment consisted of open reduction with an iliac bone graft using a buttress posterolateral plate for capitellar fracture, repair of the triangular fibrocartilage complex for distal radioulnar joint, and pinning for interosseous membrane complex. At 2 years postoperatively, plain radiographs showed bony union of the capitellum and maintained ulnar variance.
UNASSIGNED: The mainstay of treatment was to reduce the proximal migration of the radius. Physicians must pay attention to the forearm instability when see the patient with humeral capitellum fracture.

Radial-sided tears of the triangular fibrocartilage, though uncommon, can still be a reason for ulnar-sided wrist pain, and, at times, instability of the distal radioulnar joint. Historically, it has been believed that because of the paucity of vascularity along the radial edge of the triangular fibrocartilage complex (TFCC), any form of repair will not lead to healing, thus stating it to be an exercise in futility. Current literature deftly argues against this previously prevailing concept and supports the need of repair in case of symptomatic radial-sided TFCC tears. In our study, we describe an all-arthroscopic technique of repairing radial-sided tears using a bone anchor which can be a fast and simple procedure in the hands of an orthopaedic or hand surgeon trained in arthroscopy. This technique also circumvents the risk of injuring the superficial radial nerve and other radial-sided structures which are stated complications of the current arthroscopic repairs.

OBJECTIVE: This study compared the biomechanical stability of transosseous repair and transosseous combined with capsular repair techniques to reattach the triangular fibrocartilage complex (TFCC) for distal radioulnar joint instability.
METHODS: Eight adult cadaveric upper-extremity specimens were studied. Each underwent peripheral ulnar-sided detachment of the deep and superficial TFCC fibers and repair. Four groups were prepared sequentially: intact TFCC, disrupted TFCC, transosseous repair, and combined transosseous with capsular repair. Forearm rotational torque was measured in three wrist positions: 60° flexion, neutral position, and 60° extension. Maximum dorsal and palmar ulnar translations in response to a 20-N traction load were measured at nine wrist positions after stabilizing the humerus and radius. Measurements were taken before and after TFCC disruption and following repair.
RESULTS: Clear instability of the radius relative to the ulna was observed after sectioning the deep and superficial fibers of the TFCC, and stability was markedly improved after reconstruction in all positions. Compared with the normal group, rotational torque was similar between the two repair methods. In the pronation palmar flexion and supination dorsal extension positions, dorsal-palmar translation was smaller in the combined transosseous with capsular repair group than in the transosseous repair-alone group.
CONCLUSIONS: Triangular fibrocartilage complex deep fibers are the primary stabilizing structure of the distal radioulnar joint. In this cadaveric study, the combined transosseous with capsular repair technique demonstrated less dorsal-palmar translation compared with the transosseous-alone repair technique.
CONCLUSIONS: Combined transosseous with capsular repair is expected to provide improved postoperative stability for patients with peripheral TFCC tears and distal radioulnar joint instability.

Accurate diagnoses of wrist ligamentous injuries are critical to guiding the proper treatment pathway for patients with these pathologies. Although advancements in imaging continue and magnetic resonance imaging is valuable, diagnostic arthroscopy remains superior, particularly if involvement of the noncentral triangular fibrocartilage complex, scapholunate interosseous ligament, or lunotriquetral interosseous ligament is suspected on the basis of history and physical examination and even in the face of negative magnetic resonance imaging findings.

Volar dislocation of the distal radioulnar joint is a rare injury that is often missed at initial presentation. We report a 21-year-old male patient who presented 2 months after sustaining this injury. He was successfully managed by open reduction and reconstruction of the dorsal radioulnar ligament using a partial distally based extensor carpi ulnaris tendon strip. A literature review showed only a few reported cases with varied methods for management. The technique utilised is analysed in comparison to the others. Level of Evidence: Level V (Therapeutic).

Distal radius fractures are the most common fractures in adults and account for one quarter of all fractures, with increasing incidence. The number of patients and the requirement of an exact treatment are high. Continuous developments in diagnostic and operative possibilities enable in many cases a high-quality treatment with good clinical outcome; however, radius fractures rarely occur alone but in combination with additional fractures or ligamentous injuries. The frequency and extent of these injuries are not linked to the complexity of the primary injury. The aim is to recognize and correctly diagnose potential concomitant injuries. Many injuries do not need immediate treatment but heal without additional treatment after the radius has been treated. It is important to recognize those injuries which can cause severe complications if untreated; however, exactly this is often difficult. In many cases there is still no consensus if and how concomitant injuries should be treated. This article highlights the most frequent concomitant injuries in distal radius fractures with the possible advantages and disadvantages of cotreatment in order to facilitate decision making.
UNASSIGNED: Die distale Radiusfraktur ist die häufigste Fraktur des erwachsenen Menschen und macht ein Viertel aller Frakturen aus, mit steigender Inzidenz. Das Patientenaufkommen und der Anspruch an eine exakte Versorgung sind hoch. Die Weiterentwicklung diagnostischer und operativer Möglichkeiten ermöglicht in vielen Fällen eine hochwertige Versorgung mit gutem klinischem Ergebnis. Radiusfrakturen treten jedoch oft nicht isoliert, sondern in Kombination mit anderen Frakturen oder Bandverletzungen auf. Deren Häufigkeit und Ausmaß stehen mit der Komplexität der ursprünglichen Verletzung nicht im Zusammenhang. Ziel ist es, potenzielle Begleitverletzungen zu erkennen und richtig einzuschätzen. Viele Verletzungen müssen primär nicht mitversorgt werden, sondern heilen nach der Versorgung des Radius ohne zusätzliche Therapie aus. Wichtig ist es, diejenigen zu erkennen, die unbehandelt schwere Komplikationen verursachen können. Genau dies ist jedoch häufig schwierig. In vielen Fällen besteht Uneinigkeit, ob und wie eine Begleitverletzung versorgt werden sollte. Dieser Beitrag beleuchtet die häufigsten Begleitverletzungen bei distaler Radiusfraktur mit möglichen Vor- und Nachteilen einer Mitversorgung, um eine Entscheidungsfindung zur erleichtern.