Abstract
Purpose Patients with symptomatic instability of the distal radioulnar joint (DRUJ) after
traumatic complete disruption of the triangular fibrocartilage complex (TFC) are best
treated by anatomic reconstruction of the TFC. Postoperative clinical results from
the literature are known but the improvement of DRUJ instability remains still challenging
to quantify. We recently published a reliable and validated method to measure the
instability of the DRUJ. This sonographic method was used to quantify the pre- and
postoperative instability in correlation with clinical outcome in patients with complete
TFC disruption.
Methods 11 patients with complete disruption of the TFC resulting in symptomatic instability
of the DRUJ underwent open reconstruction of the TFC. The instability was measured
with sonography preoperatively and one year postoperatively including the Patient-Rated
Wrist Evaluation score (PRWE Score).
Results By subjective measurement, 9 patients showed comparable stability to the contralateral
side. By objective measurements, DRUJ stability was completely restored in 6 patients.
Seven patients had a very good and good clinical outcome. The dorsovolar shift (preoperative
mean 5.2mm, min 2.4, max 7.1; postoperative 3.6mm, min 1.2, max 6.2) was significantly
decreased (p < 0.05) and was postoperatively not different to the contralateral healthy side (p > 0.1). PRWE score in the 1 year follow up was 13.8. Three patients remained with
significant pain, sonographically two of them were still more lax and one tighter
compared to the contralateral side.
Conclusions The sonographic measurement technique allows evaluation of the stability pre- and
postoperatively and does not always correlate with the qualitative clinical assessment.
The described operation technique is effective for treatment of irreplaceable TFC
ruptures and significantly improves the DRUJ stability and wrist function one year
after surgery, which could be quantified objectively by ultrasound.
Keywords
TFC lesions - instability - ultrasound
