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Skeletal Radiology

, Volume 40, Issue 12, pp 1617–1621 | Cite as

Bucket-handle tear of the triangular fibrocartilage complex: case report of a complex peripheral injury with separation of the distal radioulnar ligaments from the articular disc

  • Nicolas Theumann
  • Ehab M. Kamel
  • Christof Bollmann
  • Michael Sturzenegger
  • Fabio BecceEmail author
Case Report

Abstract

Palmer previously proposed a classification system of triangular fibrocartilage complex (TFCC) injuries that proved to be useful in directing clinical management. However, dorsal peripheral tears (variants of class 1C) were not described and have rarely been reported in the literature since. We herewith present a rare case of bucket-handle tear of the TFCC. To our knowledge, this is the first case demonstrating partial separation of both the palmar and dorsal distal radioulnar ligaments (DRULs) from the articular disc. The particular wrist magnetic resonance (MR) arthrographic findings of this unusual complex peripheral TFCC tear (a variant of both class 1B and 1C) were nicely appreciated upon sagittal reformatted images.

Keywords

Magnetic Resonance Arthrography Articular Disc Extensor Carpus Ulnaris Triangular Fibrocartilage Complex Ulnar Styloid Process 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors gratefully thank Philippe Clavel for his computer graphics work.

Funding or grant

None.

References

  1. 1.
    Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am. 1989;14:594–606.CrossRefGoogle Scholar
  2. 2.
    Palmer AK. Triangular fibrocartilage disorders: injury patterns and treatment. Arthroscopy. 1990;6:125–32.CrossRefGoogle Scholar
  3. 3.
    Potter HG, Asnis-Ernberg L, Weiland AJ, Hotchkiss RN, Peterson MG, McCormack Jr RR. The utility of high-resolution magnetic resonance imaging in the evaluation of the triangular fibrocartilage complex of the wrist. J Bone Joint Surg Am. 1997;79:1675–84.CrossRefGoogle Scholar
  4. 4.
    Estrella EP, Hung LK, Ho PC, Tse WL. Arthroscopic repair of triangular fibrocartilage complex tears. Arthroscopy. 2007;23:729–37.CrossRefGoogle Scholar
  5. 5.
    Machiels F, Moermans JP, Brutus JP. Arthrographic and CT arthrographic findings in dorsal peripheral detachment of the triangular fibrocartilaginous complex. JBR-BTR. 2001;84:114–7.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Morisawa Y, Nakamura T, Tazaki K. Dorsoradial avulsion of the triangular fibrocartilage complex with an avulsion fracture of the sigmoid notch of the radius. J Hand Surg Eur Vol. 2007;32:705–8.CrossRefGoogle Scholar
  7. 7.
    Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka H. Ulnar-sided wrist pain. Part II: clinical imaging and treatment. Skeletal Radiol. 2010;39:837–57.CrossRefGoogle Scholar
  8. 8.
    Munk B, Jensen SL, Olsen BS, Kroener K, Ersboell BK. Wrist stability after experimental traumatic triangular fibrocartilage complex lesions. J Hand Surg Am. 2005;30:43–9.CrossRefGoogle Scholar
  9. 9.
    Corso SJ, Savoie FH, Geissler WB, Whipple TL, Jiminez W, Jenkins N. Arthroscopic repair of peripheral avulsions of the triangular fibrocartilage complex of the wrist: a multicenter study. Arthroscopy. 1997;13:78–84.CrossRefGoogle Scholar
  10. 10.
    Vezeridis PS, Yoshioka H, Han R, Blazar P. Ulnar-sided wrist pain. Part I: anatomy and physical examination. Skeletal Radiol. 2010;39:733–45.CrossRefGoogle Scholar
  11. 11.
    Raskin KB, Beldner S. Clinical examination of the distal ulna and surrounding structures. Hand Clin. 1998;14:177–90.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am. 2008;33:1669–79.CrossRefGoogle Scholar
  13. 13.
    Tay SC, Tomita K, Berger RA. The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg Am. 2007;32:438–44.CrossRefGoogle Scholar
  14. 14.
    Moser T, Khoury V, Harris PG, Bureau NJ, Cardinal E, Dosch JC. MDCT arthrography or MR arthrography for imaging the wrist joint? Semin Musculoskelet Radiol. 2009;13:39–54.CrossRefGoogle Scholar
  15. 15.
    Theumann NH, Pfirrmann CW, Antonio GE, Chung CB, Gilula LA, Trudell DJ, et al. Extrinsic carpal ligaments: normal MR arthrographic appearance in cadavers. Radiology. 2003;226:171–9.CrossRefGoogle Scholar
  16. 16.
    Benjamin M, Evans EJ, Pemberton DJ. Histological studies on the triangular fibrocartilage complex of the wrist. J Anat. 1990;172:59–67.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Haims AH, Schweitzer ME, Morrison WB, et al. Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist. Am J Roentgenol. 2002;178:419–22.CrossRefGoogle Scholar
  18. 18.
    Thiru RG, Ferlic DC, Clayton ML, McClure DC. Arterial anatomy of the triangular fibrocartilage of the wrist and its surgical significance. J Hand Surg Am. 1986;11:258–63.CrossRefGoogle Scholar

Copyright information

© ISS 2011

Authors and Affiliations

  • Nicolas Theumann
    • 1
  • Ehab M. Kamel
    • 1
  • Christof Bollmann
    • 2
  • Michael Sturzenegger
    • 3
  • Fabio Becce
    • 1
    Email author
  1. 1.Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire VaudoisUniversity of LausanneLausanneSwitzerland
  2. 2.Department of Plastic and Hand SurgeryClinique Longeraie and Centre Hospitalier Universitaire VaudoisLausanneSwitzerland
  3. 3.Division of Plastic and Hand SurgeryClinique Longeraie and Centre Médical de VidyLausanneSwitzerland

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