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.
ObjectiveTo explore the effectiveness of arthroscopic treatment of scaphoid fracture nonunion with bone graft and Kirschner wire combined with screw fixation. MethodsThe clinical data of 14 patients with scaphoid fracture nonunion who met the selection criteria between February 2021 and September 2022 were retrospectively analyzed. There were 13 males and 1 female with an average age of 32 years ranging from 17 to 54 years. The time from injury to operation ranged from 6 to 15 months, with an average of 9.6 months. According to the Slade-Geissler classification of scaphoid fracture nonunion, there were 3 cases of grade Ⅲ, 8 cases of grade Ⅳ, and 3 cases of grade Ⅴ. The preoperative visual analogue scale (VAS) score was 5.9±1.0, and the modified Mayo wrist score was 53.2±9.1. There were 2 cases of scaphoid nonunion advanced collapse, both of which were stage Ⅰ. All patients were treated with arthroscopic bone graft and Kirschner wire combined with screw fixation, and the fracture healing was observed by X-ray film monthly after operation, and the effectiveness was evaluated by VAS score and modified Mayo wrist score before and after operation. ResultsAll patients were followed up 6-14 months, with an average of 8.4 months. All fractures healed in 4-8 months, with an average of 6.3 months. The postoperative pain symptoms and wrist function of the patients significantly improved when compared with those before operation, and the VAS score at last follow-up was 2.4±1.3, and the modified Mayo wrist score was 87.1±6.7, which were significantly different from those before operation (t=12.851, P<0.001; t=−14.410, P<0.001). According to the modified Mayo wrist evaluation, 9 cases were excellent, 3 cases were good, and 2 cases were fair. Conclusion Arthroscopic bone graft and Kirschner wire combined with screw fixation is an effective surgical method for the treatment of scaphoid fracture nonunion.