title: Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears.
abstract: The classical definition of 'Palmer Type IB' triangular fibrocartilage complex tear, includes a spectrum of clinical conditions. This review highlights the clinical and arthroscopic criteria that enable us to categorize five classes on a treatment-oriented classification system of triangular fibrocartilage complex peripheral tears. Class 1 lesions represent isolated tears of the distal triangular fibrocartilage complex without distal radio-ulnar joint instability and are amenable to arthroscopic suture. Class 2 tears include rupture of both the distal triangular fibrocartilage complex and proximal attachments of the triangular fibrocartilage complex to the fovea. Class 3 tears constitute isolated ruptures of the proximal attachment of the triangular fibrocartilage complex to the fovea; they are not visible at radio-carpal arthroscopy. Both Class 2 and Class 3 tears are diagnosed with a positive hook test and are typically associated with distal radio-ulnar joint instability. If required, treatment is through reattachment of the distal radio-ulnar ligament insertions to the fovea. Class 4 lesions are irreparable tears due to the size of the defect or to poor tissue quality and, if required, treatment is through distal radio-ulnar ligament reconstruction with tendon graft. Class 5 tears are associated with distal radio-ulnar joint arthritis and can only be treated with salvage procedures. This subdivision of type IB triangular fibrocartilage complex tear provides more insights in the pathomechanics and treatment strategies.
  
  
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authors.affiliation: 1 Fenice Hand Surgery, Policlinico "San Giorgio", Pordenone, Italy.|2 Hand Surgery Unit, Casa di Cura 'Giovanni XXIII', Treviso, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Atzei
authors.affiliation: 3 Rimini Hand Surgery and Rehabilitation Center, Rimini, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Luchetti
authors.affiliation: 4 Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Garagnani
mesh_terms: D000465:Algorithms; D001182:Arthroscopy; D006801:Humans; D007593:Joint Instability / Q000145:classification / Q000209:etiology / Q000601:surgery; D051478:Triangular Fibrocartilage / Q000293:injuries*; D014954:Wrist Injuries / Q000145:classification* / Q000150:complications / Q000601:surgery*
keywords: Triangular fibrocartilage complex; arthroscopy; distal radio-ulnar joint; distal radio-ulnar joint instability; treatment algorithm; triangular fibrocartilage; wrist