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At least 379 records · Page 21Linked to original sources
PubMed2000

Anatomical reduction of intra-articular fractures of the distal radius. An arthroscopically-assisted approach.

We treated 31 intra-articular fractures of the distal radius by arthroscopically-assisted reduction and percutaneous fixation with Kirschner (K-) wires. Tears of the triangular fibrocartilage (58 %), scapholunate (85 %) and lunotriquetral (61%) instability and osteochondral lesions (19%) were also treated. A total of 26 patients was independently reviewed at an average of 19 months. The mean pain score was 1.3/10, the range of movement 79% and the grip strength 90% of the contralateral wrist. Using the New York Orthopaedic Hospital score, 88% were graded excellent to good. On follow-up radiographs, 65% had no step and 31% had a step of < or =1 mm. Pain was significantly related to the size of the step. There was a significant difference in the incidence of persistent scapholunate diastasis and the Leibovic and Geissler grade (p < 0.01): I (0%), II (0%), III (42%) and IV (100%). We recommend anatomical reduction and acceptance of a step of <1 mm since the size of the step is related to the incidence of pain.

Adult↗
PubMed1996

Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius.

Sixty patients who had a displaced intra-articular fracture of the distal end of the radius were managed with manipulative reduction and internal fixation performed under both fluoroscopic and arthroscopic guidance. According to the AO/ASIF classification system, seven fractures were type B1, two were type B2, three were type B3, thirteen were type C1, twelve were type C2, and twenty-three were type C3. Forty-one patients (68 per cent) had soft-tissue injuries of the wrist, including tears of the triangular fibrocartilage complex (twenty-six patients), the scapholunate interosseous ligament (nineteen), and the lunotriquetral interosseous ligament (nine). Thirteen patients had two soft-tissue injuries. Intracarpal soft-tissue injuries were identified most frequently in association with fractures involving the lunate facet of the distal articular surface or the radius.

Adolescent↗
PubMed2006

Arthroscopic treatment of partial scapholunate ligament tears in children with chronic wrist pain.

BACKGROUND: Scapholunate ligament injury is rare in the adolescent and pediatric population, and the results of treatment have not been well described. The purpose of the present study was to review the outcomes of arthroscopic management of patients with persistent wrist pain and scapholunate ligament injury as documented on arthroscopic examination who had had a failure of at least six months of nonoperative management. METHODS: The medical records of thirty-two pediatric and adolescent patients who underwent arthroscopic treatment of scapholunate ligament injuries were retrospectively reviewed to obtain preoperative and postoperative modified Mayo wrist scores, radiographic data, and intraoperative findings, including the classifications of interosseous ligament injury, chondral injury, and other abnormalities. Patients were contacted after a minimum of two years of follow-up for reevaluation of the Mayo wrist scores. RESULTS: Arthroscopic evaluation revealed thirty Geissler type-II tears and two Geissler type-III tears. In addition to these scapholunate ligament injuries, seven of the thirty-two patients had partial tears of the short radiolunate ligament that appeared to be at the site of impaction from carpal subluxation, twelve had a triangular fibrocartilage complex injury, and twenty-seven had a chondral injury. The modified Mayo wrist scores showed improvement following arthroscopic débridement of partial-thickness tears and associated chondral injuries. The average wrist score was 66.3 preoperatively and 91.6 at an average of forty-three months of follow-up. Eight patients required subsequent surgery because of deterioration in their clinical status. After a mean duration of follow-up of 30.8 months, the average wrist score was 87.1. CONCLUSIONS: The majority of pediatric and adolescent patients with wrist pain who have a failure of nonoperative management and who have a Geissler type-II scapholunate ligament tear on arthroscopic examination can have substantial long-term improvement following arthroscopic débridement of the tear combined with treatment of other associated injuries.

Adolescent↗
PubMed1998

Elbow, forearm and wrist injuries in the athlete.

Competitive and recreational athletes sustain a wide variety of soft tissue, bone, ligament, tendon and nerve damage to their upper extremities. Most such injuries are related to direct trauma or repetitive stress, and account for a significant amount of 'down time' for athletes participating in a wide range of sports, particularly those in which the arm is utilised for throwing, catching or swinging. Overuse injuries to the elbow include musculotendinous injuries, ulnar nerve injuries and ligamentous injuries. Osteochondrol lesions of the capitellum and posterior impingement injuries in the joint are frequently seen in athletes as well. Acute traumatic injuries to the elbow include tendon ruptures, elbow dislocations and intra-articular fractures. Forearm overuse injuries in athletes include fracture of the carpal scaphold, fracture of the hook of the hamate, Kienbock's syndrome and pisoquetral syndromes. ligamentous injuries include scapholunate, lunotriquetral and midcarpal instability injuries. Injuries to the distal radio-ulnar joint and triangular fibrocartilage are also quite common in athletes, and require careful evaluation and treatment.

Athletic Injuries↗
PubMed2000

Upper extremity injuries in the paediatric athlete.

Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.

Adolescent↗
PubMed1985

Fluoroscopic and arthrographic evaluation of carpal instability.

The efficacy of a diagnostic protocol involving videotape fluoroscopy of carpal motion and radiocarpal arthrography was evaluated in patients with wrist pain unexplained by physical examination and conventional radiographs. Videotape fluoroscopy was performed as the first study in 68 consecutive cases and was positive in 44 (66%). Radiocarpal arthrography was performed after videotape fluoroscopy in 39 of the cases (57%), including the 24 in which videotape fluoroscopy was normal and 15 others in which further information was desired in spite of positive videotape fluoroscopy. The addition of radiocarpal arthrography to videotape fluoroscopy increased the diagnostic yield to 52 (76%) of the 68 cases and excluded significant anatomic or dynamic abnormality in the others. The diagnosis was proven surgically in 25 cases. This protocol was efficacious for ligament tears of the proximal carpal row, triangular fibrocartilage tears, and proximal and midcarpal instability. Videotape fluoroscopy should be the primary method of evaluating patients with unexplained wrist pain, and arthrography should be done in those cases in which fluoroscopy is either normal or does not fully explain physical findings.

Adolescent↗
PubMed1993

Three-compartment wrist arthrography: correlation of pain site with location of uni- and bidirectional communications.

OBJECTIVE: Our objective was twofold: (1) to determine whether the site of patients' pain correlates with abnormal findings on three-compartment wrist arthrograms and (2) to determine whether the directional nature (uni- vs bidirectional) of communication(s) between adjacent wrist joint compartments shown on three-compartment wrist arthrograms correlates with the presence and site of pain. MATERIALS AND METHODS: We retrospectively studied 462 three-compartment wrist arthrograms of 458 patients. The patients were divided into four groups according to the site of pain, the correlation of that site with the site of the communication, and the directional characteristics of communications shown on the arthrogram: (1) exact correlation between site of pain and arthrographic findings, (2) correlation only between side of pain (ulnar or radial) and arthrographic findings, (3) ambiguous correlations (e.g., multifocal, midline, or diffuse pain), and (4) no correlation between site of pain and arthrographic findings. RESULTS: In 191 patients (42%), 226 intercompartmental communications were detected (51 uni- or 173 bidirectional). One hundred sixty-one patients had only one communication (uni- or bidirectional), and 30 patients had more than one (uni- and/or bidirectional) communication for a total of 65 defects. Regardless of the directional nature of the communication, no positive association between sites and/or the side of symptoms and sites of communications was demonstrable. However, a potential association appears to exist between ulnar-sided pain and combined lunotriquetral and triangular fibrocartilage tears. CONCLUSION: Our results suggest that the directional nature of interjoint communications has little or no clinical significance. Thus, with the exception of seeking the cause of ulnar-sided pain, our results question the usefulness of routine arthrography for correlating sites of patients' symptoms and individual interjoint communications.

Adolescent↗
PubMed1995

Merrill C. Sosman Lecture. MR imaging of the wrist.

Imaging of the wrist should always begin with a plain film examination. Sonography and tenography are sometimes used to evaluate tendon abnormalities. Sonography is operator dependent; tenography, because of its invasive nature, is rarely used today. Arthrography, with single or triple injection techniques, with [1] or without [2] digital subtraction, has been the procedure of choice for detecting abnormalities of the interosseous ligaments and the triangular fibrocartilage (TFC). MR imaging is the only imaging technique that can directly depict the interosseous ligaments and the TFC. It is the imaging technique of choice for the early diagnosis of aseptic necrosis, for tumor staging, and for evaluating soft-tissue masses. MR imaging enables noninvasive global examination of the wrist that is extremely sensitive in detecting osseous and soft-tissue disease. Because technical advances will allow more rapid data acquisition, thinner slices, and higher resolution, I predict MR imaging will replace arthrography in the near future.

Humans↗
PubMed1994

Surgery for posttraumatic wrist deformity. Radial osteotomy and/or ulnar shortening in 16 Colles' fractures.

16 patients with pain and impaired function after malunited fracture of the distal radius were treated with opening wedge lengthening osteotomy of the radius with bone grafting (12 cases), shortening osteotomy of the ulna (3 cases), or a combination of these methods (1 case), with or without reattachment of the triangular fibrocartilage complex. 4 patients had to be reoperated because of redislocation, resorption of the graft, fracture of the plate, or persistent non-union. At re-examination after a median of 4 years, all patients but 2 were improved by the procedure.

Adult↗
PubMed1995

Evaluation of chronic wrist pain. Arthroscopy superior to arthrography: comparison in 39 patients.

39 patients with chronic wrist pain underwent arthrography and arthroscopy to reveal disruptions of the triangular fibrocartilage complex (TFCC) and/or interosseous ligaments. TFCC disruption was diagnosed arthroscopically in 15 cases of which arthrography revealed the disruption in only 7. In 3 other patients, arthrography showed rupture of the TFCC: however, arthroscopy showed no defects. Rupture of an interosseous ligament was diagnosed arthroscopically in 6 patients in all of whom it was also revealed by arthrography. In 6 other patients, arthrography showed disruption of an interosseous ligament not verified by arthroscopy. We conclude that arthroscopy is superior to arthrography for diagnosing chronic wrist pain.

Adolescent↗
PubMed1989

Diagnosis and treatment of obscure ulnar-sided wrist pain.

Thirty-seven patients were followed for symptoms of chronic ulnar-sided wrist pain in which specific physical examination and standard radiographs were unrevealing. Initial conservative treatment did not relieve the pain. The patients underwent further diagnostic studies including dynamic cineroentgenographic evaluation and radiocarpal arthrography. Nineteen of the 37 patients were demonstrated to have a triangular fibrocartilage complex (TFCC) tear on arthrography; 18 had a normal examination. The average follow up was 23 months. Seven of the 19 patients with TFCC tears have undergone operative treatment, and 5 (71%) remain symptomatic. Of the remaining 12 patients with TFCC tears treated nonoperatively, eight (67%) have persistent symptoms. Of the 18 patients whose arthrograms were normal, five eventually underwent surgical exploration, four of which remain symptomatic. Of the 13 patients without TFCC tears treated nonoperatively, seven (54%) continue to have symptoms. In our experience, both surgical exploration and nonoperative treatment have been less than satisfying. In addition, treatment results could not be correlated with arthrographic findings.

Adolescent↗
PubMed1995

The Distal Radioulnar Joint: Problems and Solutions.

Disorders of the distal radioulnar joint are a major source of ulnar-sided wrist pain. Fortunately, our understanding of the anatomy, joint mechanics, and pathophysiology of this area has increased greatly in recent years, making resolution of many of these problems feasible. In most cases, an accurate diagnosis can be made, and successful treatment can then be prescribed. This review covers various problems affecting the distal radioulnar joint, including fractures and dislocations, triangular fibrocartilage pathology, arthritis, and other disorders.

Journal Article↗
PubMed1992

Wrist arthroscopy: an overview.

An introductory overview of wrist arthroscopy is presented. The relevant anatomy and pathology of the wrist are reviewed, with special emphasis on the triangular fibrocartilage complex. Operative technique and equipment are described, and operative indications are presented. The role of diagnostic arthroscopy is discussed and comparison is made to arthrography in terms of diagnostic efficacy. Some future directions for wrist arthroscopy are presented.

Arthrography↗
PubMed1994

Injuries of the distal radioulnar joint.

Injuries of the distal radioulnar (DRU) joint are common. If the joint is unstable or discongruous, attempts should be made to restore anatomic alignment and stability. Although most acute injuries of the DRU joint are easily treated, they are often overlooked or misdiagnosed because they usually occur in association with other major injuries of the upper limb. Acute and chronic abnormalities are described briefly and the treatment for each is discussed. Appropriate diagnosis and management of the acute injury will yield a much higher success rate than reconstructive procedures to correct a chronic disorder. A differentiation should be made between DRU joint dysfunction and ulnar impingement against the carpus; ulnar shortening is the most commonly used technique to treat the latter condition. In an elderly patient, a Darrach procedure is the preferred treatment for a DRU joint dysfunction; in younger patients, the treatment of choice appears to be resection arthroplasty of the DRU joint with preservation of the ulnar length, the ulnar styloid, and the triangular fibrocartilage complex (TFCC). In cases of malunion of the distal radius with involvement of the DRU joint, the recommended treatment is corrective osteotomy and soft tissue reconstruction of the ligamentous support of the joint.

Adult↗
PubMed1999

The value of the pronated-grip view radiograph in assessing dynamic ulnar positive variance: a case report.

Positive ulnar variance affects surgical decision making when ulnar wrist pain is refractory to conservative treatment and is either secondary to a posttraumatic triangular fibrocartilage tear or associated with ulnar impaction syndrome. In such settings, ulnar recession may be necessary to diminish load transmission across the ulnocarpal joint. We present a case of a 24-year-old man with chronic right ulnar wrist pain that illustrates the efficacy of the pronated-grip radiograph in assessing dynamic ulnar positive variance.

Adult↗
PubMed1976

[Studies of the discus articularis ulnae by use of arthrography of the wrist joint].

Lesions of the "discus articularis ulnae" (triangular fibrocartilage) are presented. Possible differences between the left and the right hand, as well as possible age and sex-linked differences were statistically analysed. In 22 wrist the disc was removed. The anatomical and pathological findings correlated with the arthrogram in all cases. Due probably to the advanced age of our study material disc lesions were found to be more frequent than in previous studies. The lesion was less frequent in men than in women. No difference could be shown between the left and the right hand. The arthrographic variations of the joint spaces adjoining the wrist were found to be symmetrically distributed. In no case could a communication between the wrist and the distal radioulnar joint be shown.

Aged↗
PubMed1999

Arthroscopy of the distal radioulnar joint.

Arthroscopy of the distal radioulnar joint is a natural extension of radiocarpal arthroscopy and can be a useful tool for certain conditions that affect this small joint. Arthroscopy provides a minimally invasive means of evaluating the distal radioulnar joint and enables visualization of the articular surfaces, synovium, and undersurface of the triangular fibrocartilage. In this article, indications, surgical techniques, and potential pitfalls of this technically demanding procedure are presented.

Arthroscopy↗
PubMed1999

[MRI in the diagnosis and differential diagnosis of radiocarpal diseases and injuries].

Advances in MRI technology have greatly improved visualization of the radio-carpal region. With todays high-resolution imaging, even very small anatomic structures like the triangular fibrocartilage may be seen. Established indications include the osteonecroses (scaphoid and lunate); however, MR images always should be evaluated in conjunction with plain radiographs. By delineating bone marrow edema, MRI is well suited for the detection of microfractures. Visualization of small soft tissue tumors, soft tissue extension of bone tumors and for staging of tumors in general may also be regarded as indications generally agreed upon. Promising indications include pathology of ligaments and similar structures.

Arthritis, Rheumatoid↗