Triangular fibrocartilage complex (TFCC) dorsal distal repair

Kienbock's disease has mysterious origins. A review of the literature suggests that excessive pressure exerted by a too long radius is the most commonly accepted etiology. The shortening of the radius becomes the most conventional technique. We add to this conventional technique, by the same incision, a curettage of the necrotic bone into the lunate and its replacement by a graft vascularized by the volar carpal artery harvested from the volar aspect of the distal radius.

Treatment of intra-articular fractures of the distal radius has changed over the past decade. The contribution of wrist arthroscopy has allowed to reduce as precisely as possible the different fragments, but mostly it also allowed to see and treat associated lesions, especially intrinsic ligament tears, often leading to frequent and disabling sequelae.

Since the outstanding Nakamura's works in 2000, followed by the more recent Atzei's works, triangular fibrocartilage complex (TFCC) tears seem more complex than previously described by Palmer. In fact, the medial insertion of the TFCC is double: classic distal peripheral as described by Palmer, and proximal into the distal fovea of the ulnar head.
In this presentation, we report a convenient and simple technique to arthroscopically repair the distal component of the TFCC.

In this key lecture, Dr. Schmelzer-Schmied looks into TFCC reconstruction.

In this key lecture, Dr. Gay focuses on arthroscopic resection of the ulno-carpal part of the ulnar head.

Ganglia of the wrist (volar and dorsal) are benign tumors that surgical treatment provides significant complications such as stiffness in flexion and unattractive scarring. Arthroscopic resection is perfectly suited for the resection of these ganglia. An update on current data from arthroscopic surgery is provided and long-term results are given in this presentation.

The origin and the physiopathology of wrist ganglia are still debated. We know for sure that most of them have a common origin on the dorsal aspect of the wrist capsule in correspondence to the scapholunate ligament. The most common explanation is that there is a valve mechanism at the base of the ganglion, which controls the variable volume of these ganglions.
Therefore, the ganglion can be healed by resecting this valve mechanism at the capsular level. Resecting greater parts of the dorsal wrist capsule can often lead to joint stiffness and secondary weakness of the dorsal capsule.
Therefore, the arthroscopic resection of the ganglion stalk will heal the ganglion using a minimally invasive technique and hence avoiding the disadvantages of open surgery.
Technically speaking, a diagnostic wrist arthroscopy is performed through the ulnocarpal portals. This allows to eliminate any co-existing pathology. It also allows to see whether the stalk of the ganglion is in an ulnocarpal or a radiocarpal position.
A shaver is then introduced through the ganglion itself into the stalk, and intensive shaving is performed at the dorsal capsule in correspondence to the origin of the ganglion. Complete resection can thereby be achieved. Special postoperative care or splinting is not necessary. Mobilization can be started immediately.

In this key lecture, Professor Liverneaux presents telemicrosurgery: robot-assisted microsurgery.

In this authoritative lecture, Dr. Krimmer focuses on distal radius fractures and looks into the principles to make complications rare.