Open repair of the ulnar disruption of the triangular fibrocartilage complex with double three-dimensional mattress suturing technique

Toshiyasu Nakamura, Yasushi Nakao, Hiroyasu Ikegami, Kazuki Sato, Shinichiro Takayama

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Open repair technique of the ulnar disruption of the triangular fibrocartilage complex is described. This technique is indicated for a fresh or a relatively fresh (less than 1 year after the initial injury) ulnar foveal detachment tear, horizontal tear, and proximal slit tear of the triangular fibrocartilage complex, all of which are accompanied by severe dorsal, palmar, or multidirectional instability of the distal radioulnar joint. A chronic tear greater than 1 year from initial injury and a fresh triangular fibrocartilage complex tear without distal radioulnar joint instability, such as central slit tear, are excluded from our indications. A dorsal C-shaped skin incision, a longitudinal incision of the radial edge of the extensor carpi ulnaris subsheath and the dorsal distal radioulnar joint capsule, exposes the distal radioulnar joint. A small, 5-mm longitudinal incision at the origin of the radioulnar ligament exposes its fovea detachment and/or the proximal slit tear of the triangular fibrocartilage complex. The disrupted radioulnar ligament is sutured in a pullout fashion to the ulna with a 3-dimensional double mattress technique through 2 bone tunnels that is precisely made at the central portion of the fovea with 1.2-mm K-wire. An additional horizontal mattress suture is used for closure of the small incision made at the radioulnar ligament, then the extensor carpi ulnaris is repaired. This open-repair technique is complex and requires precise technical skills; however, early results hav been more rewarding than the conservative treatment.

Original languageEnglish
Pages (from-to)116-123
Number of pages8
JournalTechniques in Hand and Upper Extremity Surgery
Volume8
Issue number2
DOIs
Publication statusPublished - 2004 Jun 1

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Keywords

  • Open repair
  • Pullout technique
  • Radioulnar ligament
  • Triangular fibrocartilage complex
  • Ulnar disruption

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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