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. 2020 Mar;15(2):281-286.
doi: 10.1177/1558944718793198. Epub 2018 Aug 6.

Patients With Triangular Fibrocartilage Complex Injuries and Distal Radioulnar Joint Instability Gain Improved Forearm Peak Pronation and Supination Torque After Reinsertion

Jonny K Andersson  1   2 , Elisabet M Hagert  3   4 , Jan Fridén  2   5   6
Affiliations

Patients With Triangular Fibrocartilage Complex Injuries and Distal Radioulnar Joint Instability Gain Improved Forearm Peak Pronation and Supination Torque After Reinsertion

Jonny K Andersson et al. Hand (N Y). 2020 Mar.

Abstract

Background: Forearm peak pronation and supination torque measurements are reduced up to 30% in patients with triangular fibrocartilage complex (TFCC) 1B injuries with concomitant distal radioulnar joint (DRUJ) instability. The aim of our study was to evaluate whether patients with TFCC 1B injuries, with concomitant DRUJ instability, improve in forearm peak pronation and supination torque following TFCC reinsertion surgery where postoperative DRUJ stability was achieved. Methods: We report a retrospective case series with short-term follow-up (20 months) of the postoperative forearm peak torque in pronation and supination in 11 patients (9 women/2 men, average age at surgery 32 years) operated on by TFCC reinsertion. Two of the initial 13 patients were later on reoperated due to recurring DRUJ instability and were therefore excluded in this follow-up study. Nine were treated by arthroscopic TFCC reinsertion and 2 by open technique. The forearm peak pronation and supination torque were measured pre- and postoperatively and compared with the uninjured side. Results: On average, a 16% improvement of the forearm peak torque was achieved in the injured wrist, as well as clinically assessed DRUJ stability. Functional postoperative improvement was noted in all patients, with reduced pain, good satisfaction, and acceptance of the surgery and the final result. Conclusion: We conclude that patients with TFCC injuries and DRUJ instability gain improved forearm peak pronation and supination torque after reinsertion. We also conclude that forearm peak pronation and supination torque is a valuable tool in the preoperative diagnostics of TFCC injuries with DRUJ instability as well as in the postoperative follow-up.

Keywords: arthroscopic reinsertion; distal radioulnar joint; forearm peak pronation and supination torque; triangular fibrocartilage complex; wrist.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Measurement of forearm peak supination torque of the right wrist, standing with the elbow fixed to the body and in 90° of flexion. Measurement technique developed by Peter Axelsson. Photo: Tommy Holl.
Figure 2.
Figure 2.
All-arthroscopic TFCC reinsertion with push-lock suture anchor (Arthrex). TFCC = triangular fibrocartilage complex.
Figure 3.
Figure 3.
Box-plot of the postoperative change in forearm peak torque (pronation and supination) in percentage, in the operated wrist, compared with the preoperative values. The improvements were statistically significant, P = .0098 and .0195 for pronation and supination, respectively.
Figure 4.
Figure 4.
Arthroscopic TFCC ulnar tunnel reinsertion with extra-articular push-lock suture anchor (Arthrex) fixation. TFCC = triangular fibrocartilage complex.
See this image and copyright information in PMC

References

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