Thomsen Niels O B, Björkman Anders
Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden.
J Wrist Surg. 2021 Dec 31;12(3):261-264. doi: 10.1055/s-0041-1740488. eCollection 2023 Jun.
Treatment algorithm for disruption of the triangular fibrocartilage complex (TFCC) from the ulnar fovea includes direct TFCC repair, tendon reconstruction of the radioulnar ligaments, or a salvage procedure in cases with painful distal radioulnar joint (DRUJ) degeneration. We describe our surgical technique for reconstruction of the distal oblique bundle (DOB), to attain DRUJ stability in a young man, after failed attempts of direct TFCC reinsertion and radioulnar ligament reconstruction with the Adams procedure. Reconstruction of the central band of the interosseous membrane is well recognized for Essex-Lopresti injuries that demonstrate longitudinal forearm instability. The role for reconstruction/reinforcement of the DOB to restore DRUJ stability after TFCC injury has not gained the same recognition and needs further clarification. DOB reconstruction technique described is extra-articular and technically straightforward. We believe that the procedure could be considered for patients with an irreparable TFCC injury as a part of the treatment algorithm for younger patients, who otherwise would face a more extensive salvage procedure.
三角纤维软骨复合体（TFCC）从尺骨凹处断裂的治疗方案包括直接修复TFCC、重建桡尺韧带的肌腱，或针对伴有疼痛性下尺桡关节（DRUJ）退变的病例采取挽救手术。我们描述了在直接修复TFCC和采用亚当斯手术重建桡尺韧带失败后，为一名年轻男性重建远侧斜束（DOB）以实现DRUJ稳定的手术技术。骨间膜中央束的重建在表现出前臂纵向不稳定的埃塞克斯-洛普雷斯蒂损伤中已得到广泛认可。TFCC损伤后重建/加强DOB以恢复DRUJ稳定性的作用尚未得到同样的认可，需要进一步阐明。所描述的DOB重建技术是关节外的，技术上简单直接。我们认为，对于不可修复的TFCC损伤患者，该手术可作为年轻患者治疗方案的一部分加以考虑，否则这些患者将面临更广泛的挽救手术。
