title: Reconstructive procedure for unstable radial-sided triangular fibrocartilage complex avulsions.
abstract: OBJECTIVE
  Radial-sided avulsions of the triangular fibrocartilage complex (TFCC) (Palmer 1D) with distal radioulnar joint (DRUJ) instability remain a challenging pathology to treat. We tested an intra-articular reconstruction that addresses unstable radial-sided TFCC avulsions.
  
  
  METHODS
  Ten preserved, dissected, cadaveric forearm specimens with intact TFCC and without ulnar-positive variance had biomechanical testing using a hydraulic testing device. The measurement of total displacement of the ulna relative to the radius was performed with an applied load ranging from 20 N in a volar direction to 20 N in a dorsal direction. Specimens were tested sequentially with intact TFCC, with surgically induced Palmer 1D lesions, and after reconstruction of the TFCC. All tests were performed at neutral, maximal pronation, and maximal supination.
  
  
  RESULTS
  The mean total displacements of the DRUJ of the specimens at neutral rotation were as follows: 4.1 +/- 0.4 mm for the intact specimens compared with 11.8 +/- 0.8 mm after creation of the tear and 3.9 +/- 0.7 mm for the reconstructed specimens. In maximal pronation the mean total displacements were as follows: 2.4 +/- 0.3 mm intact versus 4.9 +/- 0.7 mm for torn and 2.1 +/- 0.3 mm after reconstruction. In maximal supination the mean total displacements were as follows: 1.4 +/- 0.2 mm intact versus 5.7 +/- 1.3 mm for torn and 1.0 +/- 0.1 mm after reconstruction. All specimens obtained the preoperative pronation and supination motion after the reconstruction.
  
  
  CONCLUSIONS
  Current procedures are unable to restore DRUJ stability without a significant limitation of pronation and supination. This intra-articular reconstruction of radial-sided TFCC avulsions succeeded in restoring baseline stability to the DRUJ without interfering with pronation/supination.
authors.affiliation: Division of Orthopedic Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Martineau
authors.forename: Stephane
authors.initials: S
authors.lastname: Bergeron
authors.forename: Lorne
authors.initials: L
authors.lastname: Beckman
authors.forename: Thomas
authors.initials: T
authors.lastname: Steffen
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Harvey
mesh_terms: D001696:Biomechanical Phenomena; D002102:Cadaver; D002358:Cartilage, Articular / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D011403:Pronation; D011884:Radius / Q000293:injuries / Q000601:surgery; D019651:Plastic Surgery Procedures; D012399:Rotation; D013314:Stress, Mechanical; D013484:Supination; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery*