Anatomical transosseous fixation of the deep and superficial fibers of the radioulnar ligaments.
BACKGROUND
The triangular fibrocartilage complex is in conjunction with the interosseous membrane the most important stabilizer of the distal radioulnar joint. Lesions of the triangular fibrocartilage complex may cause instability of the distal radioulnar joint with serious consequences. Therefore, the goal is to reconstruct and provide stability to prevent further harm.


METHODS
Based on the anatomical configuration of the radioulnar ligaments, we present a technique which addresses both the deep and the superficial fibers of the radioulnar ligaments. This surgical procedure can be performed either openly or arthroscopically assisted. Two osseous 2-mm tunnels starting from the ulnar neck to the foveal surface are created. A nonabsorbable suture is passed through the tunnels and the triangular fibrocartilage using a 20-gauge venipuncture needle in order to attach the deep fibers. Then a third osseous tunnel starting from the lateral base of the styloid process to the medial aspect is created. The suture is passed through this tunnel and through the triangular fibrocartilage and around the styloid process palmarily using the same needle as before in order to anchor the superficial fibers anatomically. After reducing the ulna head the sutures are tightened.


CONCLUSIONS
This technique is quite simple and addresses the anatomical configuration of the radioulnar ligaments.
Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany, christianspies27@gmail.com.
Christian K
CK
Spies
Lars P
LP
Müller
Frank
F
Unglaub
Peter
P
Hahn
Matthias
M
Klum
Johannes
J
Oppermann
D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D053441:Suture Anchors; D013536:Suture Techniques; D051478:Triangular Fibrocartilage / Q000601:surgery*; D014457:Ulna / Q000601:surgery; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery