The distal radio-ulnar ligaments (DRUL) are key components of the triangular fibrocartilage complex (TFCC). The dorsal DRUL tightens during pronation of the forearm and helps to stabilize this motion. 12 women and three men at our clinic have been treated for DRUJ instability secondary to dorsal DRUL rupture or attenuation. Their chief complaint was pain. The dorsal DRUL was reconstructed using a tendon graft, the ends of which were anchored in the bone of the radius and ulna. This technique has been shown to correct dynamic DRUJ instability in carefully selected patients, decreasing or eliminating pain and restoring normal function.
55 patients with 64 injuries of the hand sustained while playing cricket were reviewed, 46 clinically. Most of the injuries were during fielding. The peripheral digits were most frequently involved and joint injuries predominated. Though the majority of the patients had a satisfactory functional outcome, some admitted to occasional pain and persistence of swelling and/or minor deformity. The most serious injuries were eleven fractures of the base of the middle phalanx with dislocation of the P.I.P. joint.
12 patients with pain in the piso-triquetral region are described. 11 had radiological evidence of osteoarthritis of the piso-triquetral joint, which was confirmed in the nine cases treated by excision of the pisiform. Seven of these had complete relief of symptoms. The clinical findings are constant and relief of pain by conservative treatment is usually only temporary. Ulnar nerve symptoms were present in four patients and these were also relieved by surgery. Excision of the pisiform is a useful operation for this condition, which often remains undiagnosed due to incomplete clinical and radiological evaluation. Full return to normal function is the rule if the problem is not associated with other wrist pathology.
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