Abstract
Introduction
Persistent ulnar-sided wrist pain after treatment of triquetral dorsal chip fracture even after union is a matter of concern. There could be various reasons for this persistent pain like arthritis, instability, fractures and non-union. We correlate our findings of physical examination and wrist arthroscopy as triangular fibrocartilage complex injury to be one of the causes of this persistent pain.
Patients
Six subjects who had persistent ulnocarpal joint pain and tenderness after triquetral dorsal chip fracture, despite 2 months of conservative treatment, were subjected to physical tests. If the physical examination yields positive results, then magnetic resonance imaging followed by arthroscopic treatment was performed. The six patients were then evaluated using the visual analogue scale, the Mayo modified wrist score, and the grip strength test.
Results
Triangular fibrocartilage complex (TFCC) injury was observed in all six cases and partial TFCC resection and synovectomy were performed. Analysis of the visual analogue scale, Mayo modified wrist score, and grip strength test data revealed statistically significant improvements (P < 0.05).
Conclusion
In addition to several causes reported in the published literature, TFCC injury can be a cause of persistent ulnar pain after treatment of triquetral dorsal chip fracture. Arthroscopic partial TFCC resection can be considered to be a suitable treatment for such cases.
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References
Ahn AK, Chang D, Plate AM (2006) Triangular fibrocartilage complex tears: a review. Bull NYU Hosp Jt Dis 64:114–118
Shin AY, Deitch MA, Sachar K, Boyer MI (2005) Ulnar-sided wrist pain: diagnosis and treatment. Instr Course Lect 54:115–128
Protopsaltis TS, Ruch DS (2010) Triangular fibrocartilage complex tears associated with symptomatic ulnar styloid nonunions. J Hand Surg 35:1251–1255
Bryan RS, Dobyns JH (1980) Fractures of the carpal bones other than lunate and navicular. Clin Orthop Relat Res 149:107–111
Levy M, Fischel R, Stern G, Goldberg I (1979) Chip fractures of the os triquetrum: the mechanism of injury. J Bone Joint Surg Br 61-B:355–357
Schubert H (2000) Triquetrum fracture. Can Fam Physician 46:70–71
Abboud JA, Beredjiklian PK, Bozentka DJ (2003) Nonunion of a triquetral body fracture. A case report. J Bone Joint Surg Am 85-A:2441–2444
Suzuki T, Nakatsuchi Y, Tateiwa Y, Tsukada A, Yotsumoto N (2002) Osteochondral fracture of the triquetrum: a case report. J Hand Surg [Am] 27:98–100
Park MJ, Lee JS (2010) The relationship between stress positions and pain intensity in triangular fibrocartilage lesions. J Hand Surg Eur Vol 35:735–739
Siparsky PN, Kocher MS (2009) Current concepts in pediatric and adolescent arthroscopy. Arthroscopy 25:1453–1469
Wolf MB, Kroeber MW, Reiter A, Thomas SB, Hahn P, Horch RE, Unglaub F (2010) Ulnar shortening after TFCC suture repair of Palmer type 1B lesions. Arch Orthop Trauma Surg 130:301–306
Souer JS, Lozano-Calderon SA, Ring D (2008) Predictors of wrist function and health status after operative treatment of fractures of the distal radius. J Hand Surg Am 33:157–163
Geissler W (2005) Management of scapholunate instability, 1st edn. Springer, China
Hocker K, Menschik A (1994) Chip fractures of the triquetrum. Mechanism, classification and results. J Hand Surg [Br] 19:584–588
Smith D, Murray P (1996) Avulsion fractures of the volar aspect of triquetral bone of the wrist: a subtle sign of carpal ligament injury. Am J Roentgenol 166:609–614
Tay SC, Berger RA, Parker WL (2010) Longitudinal split tears of the ulnotriquetral ligament. Hand Clin 26:495–501
Boardman MJ, Imbriglia JE (2010) Surgical management of ulnocarpal impaction syndrome. J Hand Surg Am 35:649–651 (quiz 651)
Moritomo H, Masatomi T, Murase T, Miyake J, Okada K, Yoshikawa H (2010) Open repair of foveal avulsion of the triangular fibrocartilage complex and comparison by types of injury mechanism. J Hand Surg Am 35:1955–1963
Papapetropoulos PA, Wartinbee DA, Richard MJ, Leversedge FJ, Ruch DS (2010) Management of peripheral triangular fibrocartilage complex tears in the ulnar positive patient: arthroscopic repair versus ulnar shortening osteotomy. J Hand Surg Am 35:1607–1613
Shin AY, Battaglia MJ, Bishop AT (2000) Lunotriquetral instability: diagnosis and treatment. J Am Acad Orthop Surg 8:170–179
Poehling GG (2010) Arthroscopy classics. Techniques of wrist arthroscopy. Arthroscopy 26:1683
Nguyen MK, Bourgouin S, Gaillard C, Butin C, Guilhem K, Levadoux M, Legre R (2011) Accidental section of the ulnar nerve in the wrist during arthroscopy. Arthroscopy 27:1308–1311
Waterman SM, Slade D, Masini BD, Owens BD (2010) Safety analysis of all-inside arthroscopic repair of peripheral triangular fibrocartilage complex. Arthroscopy 26:1474–1477
Estrella EP, Hung LK, Ho PC, Tse WL (2007) Arthroscopic repair of triangular fibrocartilage complex tears. Arthroscopy 23:729–737, 737 e721
Strauss NL, Goldfarb CA (2011) Arthroscopic management of traumatic peripheral triangular fibrocartilage complex tears. J Hand Surg Am 36:136–138
Yao J, Lee AT (2011) All-arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears using the FasT-Fix device. J Hand Surg Am 36:836–842
Iwasaki N, Nishida K, Motomiya M, Funakoshi T, Minami A (2011) Arthroscopic-assisted repair of avulsed triangular fibrocartilage complex to the fovea of the ulnar head: a 2- to 4-year follow-up study. Arthroscopy 27:1371–1378
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Lee, Sj., Rathod, C.M., Park, KW. et al. Persistent ulnar-sided wrist pain after treatment of triquetral dorsal chip fracture: six cases related to triangular fibrocartilage complex injury. Arch Orthop Trauma Surg 132, 671–676 (2012). https://doi.org/10.1007/s00402-011-1416-0
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DOI: https://doi.org/10.1007/s00402-011-1416-0