Anatomic Reconstruction of the Triangular Fibrocartilage Complex for the Treatment of Chronic Instability of the Distal Radioulnar Joint. A Systematic Review

Abstract

Introduction Peripheral injuries of the triangular fibrocartilage complex (TFCC) can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the reconstruction of the TFCC. The aim of the present paper was to summarize the tendon plasties of the DRUJ ligaments for the anatomic reconstruction of TFCC, to analyze the surgical techniques, and to evaluate their outcomes. Methods In order to perform a systematic review, we searched in the literature the terms DRUJ instability OR chronic distal radioulnar joint instability OR distal radioulnar tendon plasty. Results In total, 11 articles with level of evidence IV (case series) were retrieved. Most studies achieved good results, with recovery of wrist stability, improvement of the pain, and increase in grip strength in the functionality tests. In the historical evolution of the published series, wrist surgeons tried to perform a more anatomical plasty, with a more stable fixation and less invasive techniques. Conclusion The Adams procedure continues to be a valid and reproducible technique for the treatment of chronic DRUJ instability. If wrist arthroscopy and implants are available and surgeons have been technically trained, the authors recommend an arthroscopy-assisted technique, or, if possible, an all-arthroscopic TFCC reconstruction with implant fixation of the plasty in its anatomical points of insertion. Comparative studies between open and arthroscopic TFCC reconstruction techniques are needed.

Fracturas de Hueso Piramidal: Revisión Bibliográfica a Propósito de Cuatro Casos Clínicos

“…27 Si presentasen características de ser una lesión reparable (por ejemplo ausencia de lesión condral, presencia de tejido viable) nos deberíamos inclinar a un rescate quirúrgico, sobre todo, en pacientes jóvenes y en lesiones sintomáticas, existiendo múltiples opciones al respecto en función de la lesión y con buenos resultados. 26,28 Otra entidad a considerar, es la artrosis piso-piramidal, que podía estar presente previamente o presentarse de novo como consecuencia de una fractura que se extiende hacía esta articulación, y que se puede tratar según el tipo y la clínica mediante desbridamiento, exéresis del fragmento o incluso artrodesis. 29 Se han descrito buenos resultados mediante la técnica artroscópica del manejo de esta patología.…”

“…27 If they present characteristics of being a repairable lesion (for example, absence of chondral lesion, presence of viable tissue) we should be inclined towards surgical rescue, especially in young patients and in symptomatic lesions, with multiple options depending on the lesion and good outcomes. 26,28 Another condition to consider is pisotriquetral osteoarthritis, which could be previous or de novo resulting from a fracture extending into this joint. Depending on the type and symptoms, pisotriquetral osteoarthritis treatment may involve debridement, fragment excision, or even arthrodesis.…”