Wrist arthroscopic Wafer surgery combined with triangular fibrocartilage complex insertion point reconstruction in treatment of Palmer type <b>Ⅱ</b>C combined with type <b>Ⅰ</b>B ulnar impingement syndrome_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Yong , MA Mingming , RUAN Xiaojun ,  FU Yongbin

Microsurgical Repair and Reconstruction Ward of Department of Orthopaedics, Fu Yang People’s Hospital, Fuyang Anhui, 236000, P. R. China;

Corresponding author：

FU Yongbin, Email: 95224436@qq.com

Keywords：

Wrist arthroscopy; ulnar impingement syndrome; triangular fibrocartilage complex; distal radioulnar joint

DOI：

10.7507/1002-1892.202410090

Video：

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Objective To investigate the effectivess of arthroscopic Wafer surgery combined with triangular fibrocartilage complex (TFCC) insertion point reconstruction in the treatment of Palmer type ⅡC combined with typeⅠB ulnar impingement syndrome. Methods The clinical data of 14 patients with Parlmer type ⅡC combined with type ⅠB ulnar impingement syndrome who met the selection criteria between July 2021 and April 2024 were retrospectively analyzed. There were 7 males and 7 females with an average age of 43 years ranging from 16 to 59 years. The causes of injury were fall in 8 cases and sprain in 6 cases. The time from injury to operation ranged from 1 to 6 months, with an average of 2.3 months. Distal radioulnar joint instability was found in all cases. Arthroscopic Wafer surgery combined with TFCC insertion point reconstruction was used. The effectiveness was evaluated by comparing the wrist flexion-dorsiflexion range of motion, wrist ulnar deviation-radial deflection range of motion, forearm pronation-supination range of motion, visual analogue scale (VAS) score, and modified Mayo wrist score before and after operation.Results All patients were followed up 6-12 months, with an average of 9.1 months. The positive variation of ulna was (3.2±0.7) mm before operation, and the negative variation of ulna was (2.2±0.6) mm after operation. There was a significant difference in ulna variation between pre- and post-operation (t=23.851, P<0.001). The pain symptoms and forearm rotation function of the patients after operation significantly improved. At last follow-up, the wrist flexion-dorsiflexion range of motion, wrist ulnar deviation-radial deflection range of motion, forearm pronation-supination range of motion, VAS score, and modified Mayo wrist score significantly improved when compared with those before operation (P<0.05). Conclusion Arthroscopic Wafer surgery combined with TFCC insertion point reconstruction can effectively relieve wrist pain, enhance the stability of the distal radioulnar joint, and restore the function of the wrist in patients with Palmer type ⅡC combined with type ⅠB ulnar impingement syndrome.

1.	Nishiwaki M, Nakamura T, Nagura T, et al. Ulnar-shortening effect on distal radioulnar joint pressure: a biomechanical study. J Hand Surg (Am), 2008, 33(2): 198-205.
2.	Teunissen JS, Wouters RM, Al Shaer S, et al. Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients. J Orthop Traumatol, 2022, 23(1): 1. doi: 10.1186/s10195-021-00621-8.
3.	Yu H, Wang T, Wang Y, et al. Ulnar shortening osteotomy vs. wafer resection for ulnar impaction syndrome: A systematic review and meta-analysis. Int J Surg, 2022, 104: 106725. doi: 10.1016/j.ijsu.2022.106725.
4.	Onggo J, Walsh K, Darcy G, et al. Triangular fibrocartilage complex injury: outcomes of operative and non-operative management. ANZ J Surg, 2024, 94(4): 719-723.
5.	Oh WT, Kang HJ, Chun YM, et al. Arthroscopic Wafer procedure versus ulnar shortening osteotomy as a surgical treatment for idiopathic ulnar impaction syndrome. Arthroscopy, 2018, 34(2): 421-430.
6.	张云鹏, 胡宏宇, 李军, 等. 保留1/2骨膜尺骨截骨短缩联合腕关节镜探查修复三角纤维软骨复合体治疗尺骨撞击综合征. 中国骨与关节损伤杂志, 2024, 39(9): 997-1000.
7.	许涛, 王爽, 刘宏君, 等. 尺骨撞击综合征尺骨短缩结合镜下清理修复. 中国矫形外科杂志, 2024, 32(1): 31-37.
8.	Tan J, Zhang F, Liu Q, et al. Effect of different ulnar osteotomies on loading of the distal radioulnar joint: a finite element analysis. BMC Musculoskelet Disord, 2024, 25(1): 454. doi: 10.1186/s12891-024-07562-3.
9.	尹善青, 潘佳栋, 黄耀鹏, 等. 尺骨斜形截骨短缩结合腕关节镜技术治疗尺骨撞击综合征. 中华骨科杂志, 2020, 40(13): 848-855.
10.	陈宏, 滕晓峰, 袁辉宗, 等. 腕关节镜辅助尺骨头Wafer切除术与尺骨短缩截骨术治疗尺骨撞击综合征的疗效比较. 中华创伤骨科杂志, 2020, 22(11): 949-954.
11.	郑沐欣, 林晓东, 许树柴, 等. 尺骨截骨并弹性悬吊固定术治疗尺骨撞击综合征. 中国修复重建外科杂志, 2018, 32(8): 993-996.
12.	Tatebe M, Yamamoto M, Kurimoto S, et al. Do triangular fibrocartilage complex foveal injuries affect the clinical outcome of ulnar shortening osteotomy for ulnar impaction syndrome? J Orthop Sci, 2023, 28(2): 364-369.
13.	Srinivasan RC, Shrouder-Henry JJ, Richard MJ, et al. Open and arthroscopic triangular fibrocartilage complex (TFCC) repair. J Am Acad Orthop Surg, 2021, 29(12): 518-525.
14.	Jawed A, Ansari MT, Gupta V. TFCC injuries: How we treat? J Clin Orthop Trauma, 2020, 11(4): 570-579.
15.	Ward LD, Ambrose CG, Masson MV, et al. The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability. J Hand Surg (Am), 2000, 25(2): 341-351.
16.	Jung HS, Song KS, Jung HS, et al. Clinical outcomes and factors influencing these outcome measures resulting in success after arthroscopic transosseous triangular fibrocartilage complex foveal repair. Arthroscopy, 2019, 35(8): 2322-2330.
17.	Liu EH, Suen K, Tham SK, et al. Surgical repair of triangular fibrocartilage complex tears: A systematic review. J Wrist Surg, 2021, 10(1): 70-83.
18.	赵铜林, 魏本磊. 镜下穿双骨道修复三角纤维软骨复合体. 中国矫形外科杂志, 2024, 32(6): 553-556.

1. Nishiwaki M, Nakamura T, Nagura T, et al. Ulnar-shortening effect on distal radioulnar joint pressure: a biomechanical study. J Hand Surg (Am), 2008, 33(2): 198-205.
2. Teunissen JS, Wouters RM, Al Shaer S, et al. Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients. J Orthop Traumatol, 2022, 23(1): 1. doi: 10.1186/s10195-021-00621-8.
3. Yu H, Wang T, Wang Y, et al. Ulnar shortening osteotomy vs. wafer resection for ulnar impaction syndrome: A systematic review and meta-analysis. Int J Surg, 2022, 104: 106725. doi: 10.1016/j.ijsu.2022.106725.
4. Onggo J, Walsh K, Darcy G, et al. Triangular fibrocartilage complex injury: outcomes of operative and non-operative management. ANZ J Surg, 2024, 94(4): 719-723.
5. Oh WT, Kang HJ, Chun YM, et al. Arthroscopic Wafer procedure versus ulnar shortening osteotomy as a surgical treatment for idiopathic ulnar impaction syndrome. Arthroscopy, 2018, 34(2): 421-430.
6. 张云鹏, 胡宏宇, 李军, 等. 保留1/2骨膜尺骨截骨短缩联合腕关节镜探查修复三角纤维软骨复合体治疗尺骨撞击综合征. 中国骨与关节损伤杂志, 2024, 39(9): 997-1000.
7. 许涛, 王爽, 刘宏君, 等. 尺骨撞击综合征尺骨短缩结合镜下清理修复. 中国矫形外科杂志, 2024, 32(1): 31-37.
8. Tan J, Zhang F, Liu Q, et al. Effect of different ulnar osteotomies on loading of the distal radioulnar joint: a finite element analysis. BMC Musculoskelet Disord, 2024, 25(1): 454. doi: 10.1186/s12891-024-07562-3.
9. 尹善青, 潘佳栋, 黄耀鹏, 等. 尺骨斜形截骨短缩结合腕关节镜技术治疗尺骨撞击综合征. 中华骨科杂志, 2020, 40(13): 848-855.
10. 陈宏, 滕晓峰, 袁辉宗, 等. 腕关节镜辅助尺骨头Wafer切除术与尺骨短缩截骨术治疗尺骨撞击综合征的疗效比较. 中华创伤骨科杂志, 2020, 22(11): 949-954.
11. 郑沐欣, 林晓东, 许树柴, 等. 尺骨截骨并弹性悬吊固定术治疗尺骨撞击综合征. 中国修复重建外科杂志, 2018, 32(8): 993-996.
12. Tatebe M, Yamamoto M, Kurimoto S, et al. Do triangular fibrocartilage complex foveal injuries affect the clinical outcome of ulnar shortening osteotomy for ulnar impaction syndrome? J Orthop Sci, 2023, 28(2): 364-369.
13. Srinivasan RC, Shrouder-Henry JJ, Richard MJ, et al. Open and arthroscopic triangular fibrocartilage complex (TFCC) repair. J Am Acad Orthop Surg, 2021, 29(12): 518-525.
14. Jawed A, Ansari MT, Gupta V. TFCC injuries: How we treat? J Clin Orthop Trauma, 2020, 11(4): 570-579.
15. Ward LD, Ambrose CG, Masson MV, et al. The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability. J Hand Surg (Am), 2000, 25(2): 341-351.
16. Jung HS, Song KS, Jung HS, et al. Clinical outcomes and factors influencing these outcome measures resulting in success after arthroscopic transosseous triangular fibrocartilage complex foveal repair. Arthroscopy, 2019, 35(8): 2322-2330.
17. Liu EH, Suen K, Tham SK, et al. Surgical repair of triangular fibrocartilage complex tears: A systematic review. J Wrist Surg, 2021, 10(1): 70-83.
18. 赵铜林, 魏本磊. 镜下穿双骨道修复三角纤维软骨复合体. 中国矫形外科杂志, 2024, 32(6): 553-556.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesWrist arthroscopic Wafer surgery combined with triangular fibrocartilage complex insertion point reconstruction in treatment of Palmer type ⅡC combined with type ⅠB ulnar impingement syndrome

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