To evaluate the changes in stabil ity of the wrist after experimental traumatic triangular fibrocartilage complex (TFCC) lesions, and to provide basic theoretical criteria for cl inical treatment. Methods Fourteen adult cadaver upper extremities specimens were included. Two of 14 specimens were tested in pre-experiment. The specimens were tested in a INSTRON 8874 biomechanics measuring instrument. First a dorsal arthrotomy (ART) was performed, and second test was with 1 of 4 different experimental lesions according to Palmer’s classification of traumatic TFCC lesions (n=3). 1A: central perforation; 1B: ulnar avulsion with or without fracture of processus styloideus ulnae; 1C: distal avulsion with l igament injury; 1D: radial avulsion. Forced internal∕external rotation torque were recorded in the interval — 60° to 60° of flexion. Results The average torque of the dorsal ART was (0.713 ± 0.121) Nm, and the 1B-1 lesion (ulnar avulsion without ulnar styloid fracture) was (0.709 ± 0.134) Nm, the 1B-2 lesion (ulnar avulsion with ulnar styloid fracture) was (0.409 ± 0.113) Nm. The difference between the 1B-1 lesion and the dorsal ART was not significant but the difference between the 1B-2 lesion and the dorsal ART was significant (P lt; 0.05). The average torque of the 1C lesion in about 45° of wrist extention and flexion were (0.878 ± 0.184) Nm and (0.988 ± 0.197) Nm, and the dorsal ART were (1.510 ± 0.173) Nm and (1.540 ± 0.093) Nm. The difference between the two groups was significant (P lt; 0.05). The 1A lesion and 1D lesion did not alter significantly wrist stabil ity. Conclusion The 1B-2 lesion and 1C lesion alter significantly the stabil ity of the wrist.
Objective To investigate the effectiveness of three-dimentional (3D) printed personalized guide plate to assist wrist arthroscopic repair for Palmer type ⅠB triangular fibrocartilage complex (TFCC) injury. Methods A retrospective analysis was conducted on the clinical data of 20 patients with Palmer type ⅠB TFCC injuries admitted between January 2023 and March 2024 who met the selection criteria. Among them, 13 were male and 7 were female; ages ranged from 23 to 35 years, with a mean age of 30.3 years. All patients had a history of trauma, 12 cases involved falls and 8 cases involved sprains. All patients demonstrated a positive “piano key sign”. MRI revealed deep ulnar-side tears of the TFCC. Conservative treatment for 6 weeks yielded poor or no clinical improvement. The interval from injury to surgery ranged from 2 to 9 months, with a mean of 5.0 months. Patients underwent wrist arthroscopic repair assisted by 3D printed personalized guide plate. Functional recovery was assessed preoperatively and postoperatively using the visual analogue scale (VAS) score for pain, modified Mayo wrist score, and range of motion (ROM) measurements for wrist flexion-extension, ulnar-radial deviation, and pronation-supination. At last follow-up, MRI was performed to evaluate the healing of TFCC. Results All 20 patients underwent successful surgery without complications such as vascular or nerve injury, fracture, incisional infection, or joint stiffness. All patients were followed up 9-18 months (mean, 12.4 months). At last follow-up, patients demonstrated significant improvements in VAS scores, modified Mayo wrist scores, wrist flexion-extension ROM, ulnar-radial deviation ROM, and pronation-supination ROM compared to preoperative levels (P<0.05). MRI at last follow-up showed preserved TFCC continuity, excellent healing, and secure fixation. Conclusion 3D-printed personalized guide plate significantly improve outcomes in wrist arthroscopic TFCC repair for Palmer type ⅠB injuries. They enable high-quality suturing, facilitate anatomical reconstruction, and markedly enhance wrist function.
Objective To evaluate the treatment and effects of wrist arthroscopy in tear of triangular fibrocartilage complex (TFCC). Methods Between January 2006 and December 2008, 16 patients with tear of TFCC were treated. Of 16 patients, 11 were male and 5 were female with an average age of 32.5 years (range, 25-51 years). Injury was caused by sprain in 12cases, and by fall ing in 4 cases. The locations were the left side in 10 cases and the right side in 6 cases. The mean injury duration was 3 months to 6 years and 2 months. The main cl inical symptoms included wrist powerlessness and ulnar-sided wrist pain which was aggravated with clench fist and l ifting heavy things. The results of the ulnar-sided wrist stress test were positive in 14 cases and negative in 2 cases. The preoperative values of wrist range of motion (ROM) were (45.58 ± 5.18)° at volar flexion, (41.22 ± 3.83)° at dorsal extension, (17.82 ± 2.48)° at radial deviation, (21.35 ± 4.61)° at ulnar deviation, (69.85 ± 8.36)° at pronation, and (70.13 ± 6.34)° at supination. According to Palmer standard, 10 cases of IA were treated with debridement; 3 cases of IB with suture and 1 of them failed and was partially excised; 2 cases of IC with debridment on triangular fibrocartilage disc, ulnolunate l igament, and ulnotriguetrum l igament; and 1 case of ID with trimming plastic operation. Results All incisions healed by first intention, and no compl ications of joint infection or neurovascular injury was found. All patients were followed up 14-38 months (mean, 18.5 months). Fifteen patients were restored to normal l ife and work without ulnar-sided wrist pain. One patient had no pain, but he had wrist powerless. The values of ROM at last follow-up were (50.16 ± 6.21)° at volar flexion, (45.37 ± 4.65)° at dorsal extension, (18.95 ± 3.56)° at radial deviation, (26.28 ± 5.09)° at ulnar deviation, (78.87 ± 7.69)° at pronation, and (76.46 ± 8.31)° at supination; showing significant differences when compared with preoperative values(P lt; 0.05). According to Green-O’Brien standard, the results were excellent in 9 cases, good in 6 cases, fair in 1 case, and the execellent and good rate was 93.75%. Conclusion The wrist arthroscopy not only can definitely diagnose tear of TFCC, but also is useful for treatment. In addition, the incision is small and the function is easy to recover, and the occurence of chronic ulnar-sided wrist pain can be effectively avoided.