Aims

Giant cell tumour of bone (GCTB) treatment changed since the introduction of denosumab from purely surgical towards a multidisciplinary approach, with recent concerns of higher recurrence rates after denosumab. We evaluated oncological, surgical, and functional outcomes for distal radius GCTB, with a critically appraised systematic literature review.

Aims. The primary aim of this study was to assess if traumatic triangular fibrocartilage complex (TFCC) tears can be treated successfully with immobilization alone. Our secondary aims were to identify clinical factors that may predict a poor prognosis. Methods. This was a retrospective analysis of 89 wrists in 88 patients between January 2015 and January 2019. All patients were managed conservatively initially with either a short-arm or above-elbow custom-moulded thermoplastic splint for six weeks. Outcome measures recorded included a visual analogue scale for pain, Patient-Rated Wrist Evaluation, Disabilities of the Arm, Shoulder and Hand score, and the modified Mayo Wrist Score (MMWS). Patients were considered to have had a poor outcome if their final MMWS was less than 80 points, or if they required eventual surgical intervention. Univariate and logistic regression analyses were used to identify independent predictors for a poor outcome. Results. In total, 76% of wrists (42/55) treated with an above-elbow splint had a good outcome, compared to only 29% (10/34) with a short-arm splint (p < 0.001). The presence of a complete foveal TFCC tear (p = 0.009) and a dorsally subluxated distal radioulnar joint (DRUJ) (p = 0.032) were significantly associated with a poor outcome on univariate analysis. Sex, age, energy of injury, hand dominance, manual occupation, ulnar variance, and a delay in initial treatment demonstrated no significant association. Multiple logistic regression revealed that short-arm immobilization (p < 0.001) and DRUJ subluxation (p = 0.020) were significant independent predictive factors of an eventual poor outcome. Conclusion. Nonoperative management of traumatic TFCC injuries with above-elbow immobilization is a viable treatment method, particularly in patients without DRUJ subluxation. Early surgery should be considered for patients with dorsal ulnar subluxation treated with short-arm splints to prevent prolonged morbidity. Cite this article: Bone Joint J 2021;103-B(8):1386–1391

Dislocation of the distal radioulnar joint (DRUJ) in association with fractures of both bones of the forearm has received relatively little attention in the literature. The purpose of this study was to evaluate the integrity of DRUJ and evaluate the association between the level of fracture and instability of DRUJ following fracture both bones of forearm. This was a prospective study of 65 patients, over 3 years followed up for 12 months. All patients were treated with open reduction and internal fixation of radius and ulna. The mean age of the patients was 34.8 years (15–68 yrs). There were 51 males and 14 females. There were 18 fractures involving distal third of forearm, 42 fractures in the middle third and 5 fractures of the proximal third. 38 fractures (58.4%) had subluxation of the DRUJ and 27 had no DRUJ subluxation. All subluxations were dorsal. Post-operatively, 30 of the 38 fractures (78.9%) had persistent DRUJ subluxation. Of the 27 fractures, which had no pre-operative DRUJ subluxation, 10 fractures (37%) revealed dorsal subluxation in the post-operative radiographs. All fractures were immobilised in above elbow plaster casts for 6 weeks. All patients were followed up at 3, 6 and 12 months. Patients were assessed clinically, radiologically with standardised radiographs and functional assessment of grip and pinch strength using Jamar dynamometer. At 12 months, 12 patients had significant symptoms associated with DRUJ. Of these, 4 had functional restriction, which were related to complex DRUJ dislocations. DRUJ dislocations are more common in fractures, which are in the direction of the interosseous membrane (p< 0.002). They are commonly associated in fractures involving the middle and distal third of the forearm. There is a tendency for under-reporting of DRUJ dislocations in fractures of both bones of forearm and hence, more attention should be paid to this entity