Purpose
To describe a surgical approach for open repair of the triangular fibrocartilage complex
foveal avulsion via ulnar styloid osteotomy, and to assess its clinical results.
Methods
We reviewed 12 patients with distal radioulnar joint (DRUJ) instability due to isolated
foveal avulsion of DRUJ ligaments. Wrist arthroscopy was conducted for all patients
to exclude the presence of concomitant tear of the superficial part of the triangular
fibrocartilage complex and to corroborate the diagnosis with a positive hook test.
Through an ulnar approach between flexor and extensor carpi ulnaris, an ulnar styloid
osteotomy was performed under image intensifier control just ulnar to the fovea of
the head of the ulna. The avulsed foveal attachment was anchored through transosseous
sutures passing from the fovea to the neck of the ulna. The ulnar styloid was fixed
by means of screws or tension band wires. Outcome measures included clinical assessment
of pain (visual analog scale), grip strength, DRUJ instability, range of motion of
the wrist, and modified Mayo wrist score. Radiographic assessment was done to determine
union of the ulnar styloid osteotomy, DRUJ subluxation, and any hardware-related problems.
Results
Outcome measures were evaluated after a mean follow-up of 21 months. Healing of the
osteotomy was obtained in all cases by 11 weeks. The DRUJ laxity, visual analog scale,
and modified Mayo wrist score improved, while grip strength and range of motion remained
unchanged. One patient had prominent hardware necessitating removal after union of
the osteotomy. There were no reported cases of injury or neuropraxia of the dorsal
cutaneous branch of the ulnar nerve.
Conclusions
Open repair of an avulsed foveal attachment of the triangular fibrocartilage complex
using an ulnar styloid osteotomy is an alternative to either open or arthroscopic
repair approaches.
Type of study/level of evidence
Therapeutic IV.
Key Words
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Article info
Publication history
Published online: November 10, 2022
Accepted:
October 12,
2022
Received:
July 10,
2020
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
