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Postoperative Findings, Wrist
Julia R. Crim, MD; William B. Morrison, MD
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KEY FACTS

  • Imaging

    TERMINOLOGY

    • Definitions

      • Triangular fibrocartilage complex (TFCC) repair
        • Performed for traumatic tears of TFCC
        • Suture anchors may be used
      • Debridement of membranous portion of TFCC
        • Performed for degenerative tears of TFCC
        • Creates open communication between radiocarpal and distal radioulnar joints
      • Wafer procedure
        • Ulnar shortening (osteotomy of distal ulnar shaft)
        • Removal of 2-4 mm of distal ulna; styloid and head remain intact
        • Best results if TFCC intact
      • Ulnar lengthening or radial shortening osteotomies
        • Performed for Kienböck osteomalacia of lunate
      • Scapholunate (SL) ligament tear fixation
        • Acute injuries fixed with K-wires &/or sutures with suture anchors
      • Dorsal capsulodesis
        • Performed for chronic SL ligament tear
        • Blatt procedure: Flap of dorsal intercarpal ligament used to tether distal scaphoid pole to dorsal radius
      • Lunatotriquetral (LT) ligament tear fixation
        • Acute injuries fixed with K-wire fixation
      • Wrist arthrodesis
        • Many variants performed
        • Bone graft often obtained from distal radius
        • Fusion of central axis: Radius, lunate, capitate 3rd metacarpal
        • Four-corner fusion: Scaphoid excised; lunate, capitate, triquetrum, and hamate fused
        • Radiocarpal fusion: Bone graft, dorsal fixation plate
      • Proximal row carpectomy: Complete excision proximal carpal row, no fusions
        • Capitate articulates with radius
        • Preserves 60% range of motion, 90% grip strength
      • Suspensionplasty
        • Resection of trapezium, interposition of tendon (anchovy procedure) to prevent proximal migration
      • Silastic implants: Not used commonly at present
        • May replace trapezium or lunate with implant
        • Complication: Particle disease (Silastic synovitis)

    IMAGING

    • MR Findings

      • Imaging Recommendations

        DIAGNOSTIC CHECKLIST

        • Image Interpretation Pearls

          Selected References

          1. Mathoulin CL: Indications, techniques, and outcomes of arthroscopic repair of scapholunate ligament and triangular fibrocartilage complex. J Hand Surg Eur Vol. 42(6):551-566, 2017
          2. Bateni CP et al: Imaging key wrist ligaments: what the surgeon needs the radiologist to know. AJR Am J Roentgenol. 200(5):1089-95, 2013
          3. Chloros GD et al: Current concepts in wrist arthroscopy. Arthroscopy. 24(3):343-54, 2008
          4. Kuo CE et al: Scapholunate instability: current concepts in diagnosis and management. J Hand Surg [Am]. 33(6):998-1013, 2008
          Related Anatomy
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          Related Differential Diagnoses
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          References
          Tables

          Tables

          KEY FACTS

          • Imaging

            TERMINOLOGY

            • Definitions

              • Triangular fibrocartilage complex (TFCC) repair
                • Performed for traumatic tears of TFCC
                • Suture anchors may be used
              • Debridement of membranous portion of TFCC
                • Performed for degenerative tears of TFCC
                • Creates open communication between radiocarpal and distal radioulnar joints
              • Wafer procedure
                • Ulnar shortening (osteotomy of distal ulnar shaft)
                • Removal of 2-4 mm of distal ulna; styloid and head remain intact
                • Best results if TFCC intact
              • Ulnar lengthening or radial shortening osteotomies
                • Performed for Kienböck osteomalacia of lunate
              • Scapholunate (SL) ligament tear fixation
                • Acute injuries fixed with K-wires &/or sutures with suture anchors
              • Dorsal capsulodesis
                • Performed for chronic SL ligament tear
                • Blatt procedure: Flap of dorsal intercarpal ligament used to tether distal scaphoid pole to dorsal radius
              • Lunatotriquetral (LT) ligament tear fixation
                • Acute injuries fixed with K-wire fixation
              • Wrist arthrodesis
                • Many variants performed
                • Bone graft often obtained from distal radius
                • Fusion of central axis: Radius, lunate, capitate 3rd metacarpal
                • Four-corner fusion: Scaphoid excised; lunate, capitate, triquetrum, and hamate fused
                • Radiocarpal fusion: Bone graft, dorsal fixation plate
              • Proximal row carpectomy: Complete excision proximal carpal row, no fusions
                • Capitate articulates with radius
                • Preserves 60% range of motion, 90% grip strength
              • Suspensionplasty
                • Resection of trapezium, interposition of tendon (anchovy procedure) to prevent proximal migration
              • Silastic implants: Not used commonly at present
                • May replace trapezium or lunate with implant
                • Complication: Particle disease (Silastic synovitis)

            IMAGING

            • MR Findings

              • Imaging Recommendations

                DIAGNOSTIC CHECKLIST

                • Image Interpretation Pearls

                  Selected References

                  1. Mathoulin CL: Indications, techniques, and outcomes of arthroscopic repair of scapholunate ligament and triangular fibrocartilage complex. J Hand Surg Eur Vol. 42(6):551-566, 2017
                  2. Bateni CP et al: Imaging key wrist ligaments: what the surgeon needs the radiologist to know. AJR Am J Roentgenol. 200(5):1089-95, 2013
                  3. Chloros GD et al: Current concepts in wrist arthroscopy. Arthroscopy. 24(3):343-54, 2008
                  4. Kuo CE et al: Scapholunate instability: current concepts in diagnosis and management. J Hand Surg [Am]. 33(6):998-1013, 2008