Abstract. Background. We know that tears of the Triangular fibrocartilage complex (TFCC) can cause DRUJ instability and ulnar sided wrist pain. This study shows the clinical result of patients who had arthroscopic transosseous repair of the TFCC tear with DRUJ instability. Arthroscopic repair of TFCC tear is a promising, minimally invasive surgical technique especially in patients with DRUJ instability. Materials and methods. Fifteen patients who underwent TFCC one tunnel repair form 2018–2021 were reviewed retrospectively in hospital. The proximal component of TFCC was repaired through arthroscopic one- tunnel transosseous suture technique. VAS score for pain, wrist range of motion, grip strength and post operative complications were evaluated and each patient was rated according to the DASH score. Results. The patients had a TFCC tear confirmed on MRI and was confirmed on arthroscopy by doing a hook test. The patients were followed up for 6 months. Twelve patients had normal stability of DRUJ and three patients showed mild laxity compared with the contralateral side. The mean VAS score reduced from 4.7 to 0.8 (P=0.001) and grip strength increased significantly. The quick DASH score (P=0.001)also showed significant functional improvement. No surgical related complications occurred. Conclusions. Arthroscopic one tunnel transosseous TFCC foveal repair can be an excellent and safe method for repair of TFCC tear with DRUJ instability. Its a good treatment option in terms of reliable pain relief, functional improvement and reestablishment of DRUJ stability

Summary. When a TFCC tear is diagnosed, practitioners should maintain a high level of suspicion for the presence of a concomitant SL or LT ligament tear. Introduction. Disruption of the scapholunate (SL) or lunotriquetral (LT) ligament leads to dorsal and volar intercalated segment instability, respectively, while triangular fibrocartilage complex (TFCC) tears result in distal radioulnar joint (DRUJ) instability. Viegas et al. (1993) demonstrated that 56% of grossly visualised cadaveric wrists had one or more tears of a ligament or of the TFCC. The purpose of this investigation is to quantify the incidence, distribution, and correlation of SL, LT, and TFCC tears in a large group of cadaver wrists using magnetic resonance imaging (MRI). Additionally, statistical analysis was performed to predict. Methods. Spin density weighted, fat suppressed, and STIR MRI scans of the wrist were obtained in 48 fresh frozen cadaver arms using a 3 Tesla MRI scanner. The scans were scrutinised by one of us (PC) – a board certified musculoskeletal radiologist. The dorsal, volar, and membranous portions of the SL and LT ligaments were examined sequentially for the presence of a tear. Similarly, the central disk and radioulnar attachments of the TFCC were inspected for tears. Results. A ligament or the TFCC was labeled as torn if there was a complete tear, partial tear, or perforation of one or more of its components, but not if sole degenerative changes, thinning, or fraying of the fibers was observed. Four of the 48 images could not be interpreted due to unsatisfactory scans. The most prevalent injury was a TFCC tear, which was present in 28 (64%) of the 44 wrists examined. SL ligament tears were discovered in 20 (45%) of the wrists, and LT tears were present in 14 (32%) of the wrists. Moreover, 45% of the wrists examined had a TFCC tear and either a SL or LT ligament tear. Specifically, 50% of the 28 wrists with a TFCC tear had a concomitant LT tear, and 46% had a concomitant SL tear. Discussion. SL, LT, and TFCC tears were found in a substantial portion of the wrists examined. Moreover, the majority of wrists with a TFCC tear also had a SL or LT ligament tear. Viegas et al. found that 70% of wrists with a TFCC perforation also had a LT ligament tear. In our series, 71% had a TFCC tear, and 50% of those had a concomitant LT tear

There is a difference of opinion regarding the usefulness of MR Imaging as a diagnostic tool for triangular fibrocartilage complex (TFCC) tears in the wrist. Our aim was to determine the accuracy of direct magnetic resonance arthrography (MRA) in the diagnosis of triangular fibrocartilage complex (TFCC) tears of the wrist in a district general hospital setting. In a retrospective review of 21 patients who presented with complains of wrist pain and following a clinical examination, all had direct MR arthrography of the wrist in our hospital in a 1.5Tesla scanner. All had a diagnostic arthroscopy within 2-4 months of the MR scan. All patients had chronic ulnar sided wrist pain, although only two had a definite history of trauma. The findings of each diagnostic method were compared, with arthroscopy considered the gold standard. Twenty-one patients were studied (10 male: 11 female), mean age 42 years (range 27-71) years). Seventeen TFCC tears were diagnosed on arthroscopy. For the diagnosis of TFCC tears MRA had a sensitivity, specificity and accuracy of 67%. Our results echoed the opinion of some of the previous investigators with an unacceptable sensitivity or specificity for a diagnostic tool. MR arthrography needs to be further refined as a technique before it can be considered to be accurate enough to replace wrist arthroscopy for the diagnosis of TFCC tears. Other centres have reported better accuracy, using more advanced MRI technology. Until this iswidely available at all levels of healthcare the results of MRI for the diagnosis of TFCC tears should be interpreted with caution

Introduction. We reports the accuracy of direct Magnetic Resonance Arthrography (MRA) in detecting Triangular Fibrocartilage Complex (TFCC), Scapho-Lunate Ligament (SLL) and Luno-Triquetral Ligament (LTL) tears using wrist arthroscopy as the gold standard. Methods. We reviewed the records of all patients who underwent direct wrist MRA and subsequent arthroscopy over a 4-year period between June 2007 and March 2011. Demographic details, MRA findings, arthroscopy findings and the time interval between MRA and arthroscopy were recorded. The scans were performed using a 1.5T scanner and a high resolution wrist coil. All scans were reported by a musculoskeletal radiologist. Sensitivity, specificity, positive and negative predictive values (PPV & NPV) were calculated. Results. Two hundred and thirty four (234) MRA were performed over the study period. Fifty patients (50), who subsequently underwent 51 wrist arthroscopies (one bilateral), were included. The mean age was 35 years (range 16–64 years). The average delay between MRA and arthroscopy was 4.8 months (median 4 months, range 17 days–18 months). All patients were symptomatic with wrist pain. At arthroscopy, 26 TFCC tears, 7 SLL tears and 3 LTL tears were found. For TFCC, sensitivity was 96%, specificity 88%, PPV 89% and NPV 96%. For SLL, the values were 57%, 66%, 21% and 91% respectively. For LTL, 67%, 79%, 17% and 97%, respectively. Receiver Operating Characteristic (ROC) curve analysis showed that MRA only reliably differentiates between patients with and without TFCC tears (Area Under Curve AUC = 0.92, p < 0.0001) but not SLL (AUC = 0.62, p=0.28) or LTL (AUC = 0.73, p=0.17) tears. Conclusion. MRA is a sensitive and specific imaging modality for diagnosing TFCC tears. However, the diagnostic accuracy for SLL and LTL tears was not satisfactory. Wrist arthroscopy remains the gold standard if there is a clinical suspicion of inter-carpal ligament tears

Objective. Retrospective study to assess the outcomes of ulnar shortening for TFCC tear and distal radial malunion. Method. Retrospective note and x-ray review of all patients undergoing ulnar shortening over a ten year period along with a clinic assessment and scoring to date. The ulnar shortening was performed using the Stanley Jigs (Osteotec). A 5–6 holed DCP was used to stabilize the osteotomy site. Physiotherapy was commenced immediately following the surgery to promote prono-supination and wrist exercises. Result. 28 patients studied with one subsequent death. 13 patients with an average age of 53 years underwent ulnar shortening for distal radius malunion, whereas 15 pateints with an average age of 47 years had a primary indication of ulnar abutment with TFCC tear. Six patients underwent reoperation for non-union. 2 patients needed plate removal for prominent metalware. Patients undergoing the procedure for TFCC deficiency compared to radial malunion did worse, on functional scoring (DASH & SF36). Failure to place an interfragmentary screw was associated with a higher risk of non-union. Conclusion. Ulnar shortening is not a benign procedure, especially for the treatment of TFCC insufficiency. Interfragmentary screw placement is important in avoiding non-union

Purpose: The purpose of this study was to evaluate the long-term results of arthroscopic treatment in patients affected by triangular fibrocartilage complex (TFCC) type 1b lesions associated with distal radio ulnar joint (DRUJ) instability. Method: 138 patients affected by TFCC type 1b lesions: Group A (117 patients, 27±7 yrs) were treated using an out-in arthroscopic technique and Group B (21 patients, 24±4 yrs) with an associated total DRUJ instability, were treated using an out-in arthroscopic technique in addition to an anchor placement. Inclusion criteria were: TFCC tears, type 1b lesions and no previous wrist fractures. SF-36, DASH, VAS, and ROM were accessed preoperatively and at four years follow-up. Results: All the patients have a significant improvement in terms of SF-36 (p0.05). Conclusion: Arthroscopy is a tool of paramount importance in both diagnosis and treatment of TFCC injuries even associated with DRUJ. Furthermore, type 1b lesions associated with total DRUJ instability should be managed combining an out-in arthroscopic technique with the use of an anchor to completely relieve pain and restore wrist function

The aim of the study was to compare the radiological findings of wrist arthrogram with wrist arthroscopy. This allowed us to establish the accuracy (sensitivity, specificity) of MRI arthrogram as a diagnostic tool. Thirty patients (20 female and 10 male) have undergone both wrist MRI arthrogram and wrist arthroscopy over the last 3 years at Macclesfield District General Hospital. The mean age at arthrogram was 42.4 years with an average 6.7 month gap between the two procedures. The MRI arthrogram was reported by a consultant radiologist with an interest in musculoskeletal imaging and the arthrosopies performed by two upper limb surgeons. Patients undergoing both procedures were identified. The arthrogram reports and operation notes were examined for correlation. Three main areas of pathology were consistently examined: TFCC (triangular fibrocartilage complex), scapholunate and lunatotriquetral ligament tears. The sensitivity and specificity of arthrogram was calculated for each. Other areas of pathology were also noted. In the case of TFCC tears MRI arthrogram had a 92.3% sensitivity and 54.6% specificity. The lunatotriquetral ligament examination with this technique was 100% sensitivity and specificity. However for scapholunate ligament tears it only had 50% sensitivity and 77.8% specificity. Wrist arthrogram and arthroscopy are both invasive techniques and equally time consuming. In cost terms the arthrogram remains cheaper but is superseded by arthroscopy as it is both diagnostic and therapeutic

Scaphoid non-union usually requires surgical treatment in form of reconstructive or salvage procedure. Imaging helps in planning the surgical procedure. Wrist arthroscopy may also be helpful in the pre-operative assessment. This study was conducted to find the usefulness of wrist arthroscopy in formulating a management plan to treat scaphoid non-union. We prospectively studied 17 patients of scaphoid non-unions by wrist arthroscopy. Non-union was assessed; and site and extent of any articular wear if present was noted. Some patients had additional procedures such as synovial debridement, removal of loose bodies or debridement of TFC tears. It was possible to formulate the further management plan at the same time. Our study included 14 men and 3 women with a mean age of 34.5 years (range 18 to 49). Arthroscopic findings included mild radiocarpal wear in 3 cases and severe articular wear in 1. Additionally, in two thirds of cases there was some degree of wear present over the radial styloid region. 6 cases had TFCC tears. 4 patients had synovial debridement and in 5 cases loose bodies were removed. Based on the arthroscopic findings, it was decided to proceed to a reconstructive procedure in 12 cases and a salvage procedure in remaining 5. We concluded that in scaphoid non-unions:. Articular surface wear is often less than suggested by imaging. Limited wear is often present at radial styloid area which could be debrided. Associate abnormalities such as loose bodies, synovitis and TFC tears are commonly present. State of union can not be accurately assessed due to presence of fibrocartilage at the non-union site

Aim. This study reviewed the efficacy of a CT arthrogram in clinical decision making for wrist disorders. Methods. Sixty four consecutive CT arthrograms done in a three year period at Glenfield Hospital were selected. All patients were referred by hand consultants at the Glenfield Hospital and all investigations were performed by a single senior musculoskeletal radiologist. CT arthrograms focussed on the following areas: scapholunate interosseous ligament (SLIL), lunotriquetral interosseous ligament (LTIL), peripheral and central triangular fibrocartilage complex (TFCC) tears, and articular surface disorders. Referral and clinic letters for all patients were obtained. We collected patient demographic detail, prescan diagnosis and clinical plan, CT arthrogram findings, postscan diagnosis and clinical plan and the final outcome. A decision was made whether the scan helped in the clinician's management plan and if so how it helped. Results. There were 35 male and 29 female patients with a mean age of 44.1 years. The right wrist was involved in 42 and the left in 22 patients. Sixty three of the 64 patients had their management based on the CT scan. In 54 of these the CT arthrogram either confirmed and calibrated the diagnosis or identified a new diagnosis. In 10 patients the scan was normal and allowed patient reassurance. Thirty six patients had ulnar sided problems, 20 had radial sided disorders and eight had midcarpal abnormality. The most common abnormality noted was a TFCC tear (24). The next most common was chondral damage/arthritis (14) followed by scapholunate interosseous ligament tear (12). The diagnosis was either confirmed and its extent established (31) or identified in addition to the primary diagnosis (19). Conclusions. The CT arthrogram is a helpful tool in the management of intra-articular wrist pathology. We found it to be useful in both confirming and calibrating the diagnosis and also diagnosing occult patho

Introduction. Scaphoid fracture is the most common undiagnosed fracture. Occult scaphoid fractures occur in 20-25 percent of cases where the initial X-rays are negative. Currently, there is no consensus as to the most appropriate investigation to diagnose these occult frctures. At our institution MRI has been used for this purpose for over 3 years. We report on our experience and discuss the results. Materials and methods. All patients with occult scaphoid fractures who underwent MRI scans over a 3 year period were included in the study. There was a total of 619 patients. From the original cohort 611 (98.7%) agreed to have a scan, 6 (0.97%) were claustrophobic and did not undergo the investigation and 2 (0.34%) refused an examination. 86 percent of the cases were less than 30 years of age. Imaging was performed on a one Tiesla Siemen's scanner using a dedicated wrist coil. Coronal 3mm T1 and STIR images were obtained using a 12cm field of view as standard. Average scanning time was 7 minutes. Results. The majority of the scans were performed within 2 weeks of the request. The breakdown of results is as follows: Normal 45%; Scaphoid bruise 10%; Scaphoid fracture 9%; Distal radius fracture 8%; Distal radius bruise 7%; TFCC tear 4%; Wrist ganglion 3%; Basal thumb arthritis 3%; Miscellaneous 12%. We did not have any missed scaphoid fractures during this period. Conclusions. Patients with a clinically suspected scaphoid fracture could have a wide range of possible diagnoses. Almost half the patients had a negative scan and therefore did not require further immobilisation/activity restriction. It is possible to perform MRIs within a reasonable timeframe in a DGH setting. Patient acceptance was very high (99%). There were no missed diagnoses. Scaphoid bruising could be picked up and consequently unnecessary immobilisation avoided. In patients with other diagnoses a reliable prognosis could be given

Introduction. The wrist arthroscopy has been performed since 1979. With the advances in technology and surgical expertise, wrist arthroscopy has become third commonest procedure after knee and shoulder joint. Wrist arthroscopy has become a gold standard for diagnosing TFCC pathologies and other intercarpal disorders. Our aim was to compare the clinical, MRI and arthroscopic findings while treating various wrist pathologies. Materials/Method. In retrospective trial, 30 patients (19 male and 11 female) with clinical evidence of wrist lesions were evaluated with MRI followed by wrist arthroscopy. The mean age of the patients at the time of outpatient appointment was 44 years with an average waiting time of 6.6 months. Inclusion criteria: all patients undergoing wrist surgery. Exclusion criteria: septic arthritis, acute distal radius fractures. Kappa analysis was used to compare the three methods of wrist pathology assessment. The total 30 patients were assessed for clinical findings, MRI report and corresponding arthroscopic findings. Results. According to the clinical findings, 22 patients (68% of all patients) were diagnosed with suspected TFCC injury. In 21 patients, the MRI showed TFCC tear (partial to complete) and this was confirmed by arthroscopy in 22 patients. There was a correlation of clinical, MRI and arthroscopy in detecting TFCC lesions in 95% cases. Sensitivity 93%, specificity 90%, positive predictive value 89% and negative predictive value 94%. The Scapho-lunate ligament tear was suspected in 8 (28% of all patients). In 6 patients, MRI showed scapho-lunate tear and this was confirmed by wrist arthroscopy in 10 patients. Correlation with wrist arthroscopy was 80%, sensitivity 94%, specificity 92%, positive predictive value 90% and negative predictive value 93%. 15 patients (50% of all patients) showed signs of moderate to severe cartilage wear and 12 patients had confirmation with MRI. Correlation with wrist arthroscopy was 75%, Sensitivity 90%, Specificity 91%, positive predictive value 89% with negative predictive value 92%. However clinical examination and MRI had poor correlation with wrist arthroscopy in diagnosing synovitis. Discussion. The MRI and wrist arthroscopy has fair correlation, though MRI sensitivity approaches that of arthroscopy, it cannot replace it at the moment. However, it is a potent additional tool for wrist diagnosis if intra-articular contrast is used. It can facilitate diagnosis and indications for surgery of the wrist. It may make arthroscopic and more invasive interventions for diagnostic purposes avoidable in future. Our results showed clinical examination is crucial for diagnosing wrist pathologies, MRI can be used as an adjunct but the wrist arthroscopy still remains the gold standard tool for diagnosis and therapeutic interventions

Background and Objectives. Triangular fibrocartilaginous complex (TFCC) tears are common sources of ulna sided wrist pain and resultant functional disability. Diagnosis is based on history, clinical examination and radiological evidence of a TFCC central perforation or radial/ulna tear. The purpose of this study is therefore to evaluate the diagnostic accuracy of Magnetic Resonance Imaging (MRI) and Magnetic Resonance Arthrography (MRA) in the detection of TFCC injury in the adult population. Methods. Published and unpublished literature databases were systematically review independently by two researchers. Two-by-two tables were constructed to calculate the sensitivity and specificity of MRI or MRA investigations against arthroscopic outcomes. Pooled sensitivity and specificity values and summary Receiver Operating Characteristic curve (sROC) evaluations were performed. Methodological quality of each study was assessed using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool. Results. Twenty one studies were eligible, including 910 wrists. On meta-analysis, MRA was superior to MRI in the investigation of complete TFCC tears with a pooled sensitivity of 0.75 (95% Confidence Interval (CI): 0.70, 0.79) and specificity of 0.81 (95% CI: 0.76, 0.86), compared to MRAs 0.84 (95% CI: 0.79, 0.89), and 0.95 (95% CI: 0.92, 0.98) respectively. MRA and MRI performed at greater field strengths reported greater sensitivity and specificity findings. For 3.0 Tesla (T) MRI, the meta-analysis indicated a sensitivity of 0.86 (95% CI: 0.65, 0.97), and specificity of 1.00 (0.87, 1.00). In comparison, the pooled sensitivity for the 1.5T MRI assessment was 0.70 (95% CI: 0.64, 0.75) and specificity of 0.79 (95% CI: 0.72, 0.85). This trend was repeated for MRA where 3.0T MRA exhibited a sensitivity was 1.00 (95% CI: 0.79, 1.00) and specificity of 1.00 (95% CI: 0.82, 1.00), whilst pooled analysis 1.5T MRA demonstrated a sensitivity of 0.83 (95% CI: 0.78, 0.89) and specificity of 0.95 (95% CI: 0.91, 0.98). There was insufficient data to assess the diagnostic test accuracy of partial TFCC lesions. Conclusions. Given its acceptable diagnostic test accuracy, it is recommended that in cases where there are questions over the diagnosis and subsequent management of patients with ulna wrist pain, a MRA should be undertaken rather than MRI

Purpose: The purpose of this study is to investigate the external and internal vascular anatomy of the lunate bone. The genesis of lunatomalacia requires some combination of load, vascular risk and mechanical predisposition. The findings will be correlated with the major existing theories of the cause of lunatomalacia and the most frequent fractures associated with Kienbocks disease: transverse shear fracture and midcoronal fracture. Material and methods: We studied 21 cadaver upper limbs using latex injection and Spalteholz technique. We investigated the extra- and intraosseous blood supply. In 17 wrists we evaluate the incidence and distribution of anatomic features, arthrosis, and soft tissue lesions. Results: The lunate morphology was 5 Type I (29.4%), 11 Type II (64.7%) and 1 Type III (5.9%). The lunate was found to have a separate facet for the hamate in 47.1% (Size 3–6 mm). Most frequent arthrosis was identified in the radius (88.2%) and lunate (94.1%). The triangular fibrocartilage complex (TFCC) was found torn in 47%, the lunotriquetral interosseous ligament (LTIL) was torn in 23.5%, and the scapholunate interosseous ligament (SLIL) was torn in 53% of the wrists. Statistical analysis found a correlation between the presence of arthrosis at the proximal pole of the hamate and the presence of a lunate facet. There was also a correlation between the presence of a tear in the SLIL and the presence of cartilage erosion in the scaphoid (p= 0.002). Arthrosis on the lunate was found to have a correlation with an SLIL tear or TFCC tear. The nutrient vessels entered the lunate throught the dorsal and volar poles in all the specimens. Dorsal vessels enter the bone through one or two foramina in the proximal, ulnar, and nonarticular aspect of the bone. Two to six nutrient vessels were observed entering the volar pole throught a ligament insertion: radioscapholunate ligament of Testut-Kuentz, radio-lunate-triquetrum ligament and ulnar-lunate-triquetrum ligament. Conclusions: The lunate had consistent dorsal and palmar arteries entering the bone in all the specimens. The supply blood and foramina number is more important in the volar pole of the lunate than the dorsal pole. The vascular patterns support a theory of compression fracture from repeated trauma, or anatomical predispositions as the most likely cause of Kienbocks disease

Summary. Increased lateral ulnotrochlear joint space due to improper sizing in radial head arthroplasty may result in medial collateral ligament laxity, leading to increased osteophytes and arthritis. Introduction. Radial head (RH) arthroplasty is a common response to comminuted RH fractures. Typical complications include improper sizing, leading to changes in joint kinematics. Evidence of these changes should be visible through fluoroscopic images of affected joints. The two examined changes in this study are the ulnar deviation from distal radial translation (DRT), and the widening of the lateral ulnotrochlear joint space (LUT). Methods. Eight fresh-frozen cadaver arms were used. Initial images were taken with the native RH intact. The Kocher approach exposed the radiocapitellar (RC) joint capsule, preserving all ligaments. The RH was excised and Integra Katalyst CoCr (Plainsboro, NJ) telescoping, bipolar, RH inserted. Images were taken with implant sizings: −2mm, 0mm, +2mm, and +4mm, (from native) using 1mm washers preventing implant bipolarity. AP fluoroscopic images of the elbow were taken at full extension. Joint spaces were measured using image analysis, normalised using known radio-opaque lengths. Four LUT measurements were made, two medially and two laterally, and normalised by measuring the RH implant diameter. Each set (medial and lateral) were averaged together and the resulting value used for all comparisons. Images of distal ulnar deviation at the wrist were taken with the wrist in supination, the hand rotated medially. Measurements were from the distal medial radial tip to the distal lateral ulnar tip. Images were normalised by placing a scalpel in the same plane as measurement. Results. DRT values were difference paired for each arm using the 0mm values as baselines. One-way ANOVA of the paired values resulted in significant DT with sizing increases (p<0.01). The quotient of DRT and sizing determined comparative impact with the LUT increase. LUT joint gap measurements were percentage paired, with natives as the baseline, and One-way ANOVA used. A significant increase in LUT spacing occurred with increased sizings (p<0.01). Discussion. Increased ulnar deviation can increase loading on the TFCC, leading to possible TFCC tear, increased articular cartilage wear from carpal misalignment, and eventual wrist instability and arthritis. The percentage of the radial lengthening is represented in DRT. Over-sizing results in small percentages of increased radial length at the wrist, therefore deviation at the elbow must take place, either through rotation of the ulna, or translation. Either of these can be seen through LUT measurements. Previous measurements of the LUT space were made by Frank (2009), with similar results. This was being used as a method of improper sizing detection using radiographs. The percentage difference of LUT space for corresponding sizing: there is an increase in LUT space for every sizing; maybe due to loosening of the soft tissue from arthroplasty. Increased LUT space indicates the medial translation of proximal ulna. This can result in Medial Collateral Ligament laxity, leading to increased osteophytes, and arthritis. Use and non-treatment, can create a chronic, painful, disorder

Laboratory evidence has shown that tears within the substance of the triangular fibro-cartilaginous complex (TFCC) of the wrist are caused by shear and/or compressive forces rather that by distraction. They are commonly associated with ulnocarpal abutment syndrome (UCAS). A number of different methods of treatment have been advocated for UCAS but no satisfactory comparison of these has been reported. To compare the results of different forms of treatment for UCAS. The notes of 76 patients who had undergone wrist arthroscopy for UCAS were reviewed independently. The diagnoses made at the time of the arthroscopies and any surgical interventions (shaving the torn TFCC back to stable tissue, wafer resection of the ulnar head, repair of the TFCC) that were made at the same time were recorded. The results of these interventions were noted, as were any subsequent surgical procedures for persisting pain. These results were compared with those of a meta- analysis of the results for similar procedures published in the literature. All 76 patients had TFCC tears, four were repaired arthroscopically and the remainder underwent debridement. Nineteen of these had, in addition, arthroscopic wafer procedures carried out. Of the 53 who had only debridement 63% were graded as good or excellent. The remainder underwent formal ulnar recessions and 93% of these improved and were graded as good or excellent. Of the 19 who had wafer procedures 53% were graded as good or excellent. Seven (36%) of this group underwent ulnar recessions with five (66%) improving to be graded as good or excellent. There were no major complications such as infection, nonunion or failure of the internal fixation. Of the four cases in which the TFCCs were repaired arthroscopically, three were graded as good or excellent. One remained the same and underwent and ulnar recession and improved to be graded as good. From the meta-analysis 72% of patients who were treated by debridement alone were graded as good or excellent, while 66% were good or excellent after debridement combined with a wafer procedure. The patients who were treated by ulnar recession had a larger proportion of good or excellent results with 92% reaching this level of satisfaction. From these results it was concluded that arthroscopic debridement of tears of the TFCC was effective treatment in a majority of patients. The arthroscopic wafer procedure was effective as long as adequate bone was resected. Persisting symptoms of UCAS were very adequately treated by ulnar recession

Aims

Wrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic prophylaxis (PAP) is still widely used in wrist arthroscopy.

Aims

The aim of the Scaphoid Magnetic Resonance Imaging in Trauma (SMaRT) trial was to evaluate the clinical and cost implications of using immediate MRI in the acute management of patients with a suspected fracture of the scaphoid with negative radiographs.

The August 2012 Wrist & Hand Roundup³⁶⁰ looks at: the Herbert ulnar head prosthesis; the five-year outcome for wrist arthroscopic surgery; four-corner arthrodesis with headless screws; balloon kyphoplasty for Kienböck's disease; Mason Type 2 radial head fractures; local infiltration and intravenous regional anaesthesia for endoscopic carpal tunnel release; perilunate injuries; and replanting the amputated fingertip.