Background The triangular fibrocartilage complex (TFCC) lesions are frequently implicated as a cause of ulnar wrist pain following impact and loading injuries. The objective of this study was to describe the clinical outcomes following TFCC lesion repair with the arthroscopic outside-in technique.
Description of Technique We inserted a 21-gauge needle with 4–0 nylon loop perpendicular to the injured triangular fibrocartilage (TFC). We held two 4–0 nylon loops with mosquito forceps, drew them once out of the joint through a 4 to 5 portal, and put both sides through each loop. After that, we pulled out the 21-gauge needles and performed outside-in sutures after making a small incision and tying directly over the capsule.
Patients and Methods Twenty-one wrists who underwent arthroscopic capsular repair were included. Arthroscopic findings were evaluated, and we used a distal radioulnar joint (DRUJ) evaluation system to monitor relief of pain, forearm rotation range of motion, and DRUJ stability postoperatively.
Results Simple ulnar avulsion (Palmer 1B, Atzei Class 1) was recognized in ten wrists. A combination of the 1B tear with a horizontal TFC tear was noted in five wrists; and ulnar avulsion extending to the dorsal half of the TFC was identified in six wrists, including complete dorsal avulsion of the TFC from the capsule. There are significantly better results in the cases whose preoperative periods were 15 months or less.
Conclusion The outside-in TFC repair technique produced excellent clinical results for peripheral detachment of the TFC in cases without severe DRUJ instability and with a preoperative period less than 15 months.
In order to obtain information on the cause of low field shift of 1H NMR signals of ‘acetylene-cumulene’-dehydroannulenes on introduction of substituents, the syntheses of 1,8-bisdehydro[14]- and 6,8,15,17-tetrakisdehydro[18]annulenes bearing p-substituted phenyl group(s) have been performed. The examination of their 1H NMR spectra indicates that the low field shift of NMR signals can be regarded as a superposition of three effects, i.e., 1) decrease of ring current in annulene nucleus by perturbation of substituent group(s), 2) Deshielding effect of ring current in aryl substituent(s) exerted on annulene protons, and 3) Electronic effect of p-substituent in phenyl group(s) transmitted to annulene ring.
The cases of two patients, a four-year-old boy and an eight-year-old boy, who had been incapable of active flexion of the little finger since birth, are presented. They were capable of active flexion of the metacarpophalangeal (MP) joint, but not of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints. They were diagnosed with a defect of the flexor digitorum profundus (FDP) tendon of the little finger and underwent surgery. In both cases, the FDP tendon turned into fibrous tissue proximal to the palm and lost continuity on this side. Reconstruction was performed by making an end-to-side anastomosis of the residual proximal end of the FDP tendon to the FDP tendon of the ring finger in the palmar region. Although one patient required repeated surgery due to post-operative tendon adhesion, good outcomes were achieved, with both patients becoming capable of active flexion.
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