Clinical Research On Arthroscopic Repair Of TFCC In The Treatment Of Distal Radius Fracture With DRUJ Instability

Objective:To analyze the clinical efficacy of an arthroscopic repair triangular fibrocartilage complex(TFCC)in the treatment of Distal radius fracture combined with acute instability of the Distal radioulnar joint(DRUJ).Methods:The clinical date 27 patient who received surgical treatment in the Department of Hand Microsurgery of The First Affiliated Hospital of Dalian Medical University from February 2019 to February 2020 were retrospectively analyzed.the patient go on arthroscopic repair of TFCC for treatment of distal radius fracture complicated with acute DRUJ instability.There were 8 males and 19 females,aged 17-70(52.8±14.0)years.Among the 27 patients,20 are Colles fracture and 7 are Simth fracture.There were 14 patients with ulnar styloid fracture(12 patients with ulnar styloid basal fracture,2 patients with ulnar styloid non-basal fracture),and 13 patients without ulnar styloid fracture.9 cases with Ⅰ degrees unstable DRUJ,18 cases with Ⅱunstable DRUJ,0 cases with Ⅱ unstable DRUJ.Palmer classification:13 patients with Palmer 1A;21 cases with Palmer 1B;7 cases with Palmer 1D.Estrella classification:dorsal tear of TFCC injury was found in 2 cases;Atzei classification:complete TFCC tear occurred in 17 cases;proximal TFCC tear was found in 4 cases.Nakamura classification:1D-a type in 2 patients and 1D-d type in 5 patients.All patients used Ballottement trial to classify the stability of the radial joints.Moreover,we explored the wrist joints in patients with unstable distal radius fracture merge DRUJ to assess and classify the damage degree of TFCC,synchronously,we repaired the injury part of TFCC.Palmer type 1 b or dorsal tear TFCC damage was repaired by soft tissue suture;Nakamura type 1d-D TFCC injuries were treated by Kirschner wire fixation of the dorsal radius block.The forearm was fixed in middle position by braces for 6 weeks after the surgery.The Kirschner wire fixed to the dorsal ulnar bone block of the radius as well as the forearm bracing were removed 6 weeks after the surgery in Nakamura 1d-D(dorsal ulnar bone block type)TFCC injury patients,and then the functional exercise was performed under the guidance of surgeons;The Press test and Ballottement test was performed 12 months to assess DRUJ stability.The extension and flexion scope of motion of both injured and healthy wrist and the scope of rotation of the forearm and the power of gripping were measured for analysis.The PRWE and Cooney grade were performed to evaluate the clinical efficacy of arthroscopic repaired TFCC in the treatment of distal radius fractures with acute DRUJ instabilityResults:27 patients were followed up for 12 months our cases of Nakamura 1d-D type TFCC injuries were repaired by Kirschner wire fixation of dorsal ulnar bone block,and one case of Palmer 1B combined with Nakamura ld-D type TFCC injury was repaired by soft tissue suture and Kirschner wire fixation of dorsal ulnar bone block.6 weeks after operation,the incision was free of infection and healing was good.There was no loosening of the Kirschner wire in 5 patients who received Kirschner wire fixation for dorsal ulnar bone block.Wrist pressure test and Ballottement test were negative in all patients 12 months after operation,and DRUJ was stable without ulnar wrist pain.The average flexion and extension motion of the affected wrist was 150.11°±7.17°.The average flexion and extension activity of the affected wrist was 90.19%±4.49%of that of the healthy wrist.The internal and external rotation range of the affected forearm was 148.89°±10.48°,and the average rotation(pronation and supination)range of the affected forearm was 96.67%±3.41%of that of the healthy forearm.The grip power of the injuerd side was 280.50N±92.69N,and the mean grip power of the affected side was 90.07%±3.22%of that of the healthy side.PRWE wrist score(4.37±3.72),24 patients’ Cooney wrist score was excellent,3 patients’ Cooney wrist score was good.Conclusion:Arthroscopic repair of TFCC in the treatment of distal radius fracture combined with acute DRUJ instability can effectively restore DRUJ stability and wrist function,reduce wrist pain,and the clinical efficacy is satisfactory.