Designing a 20 mm incision to protect the dorsal branch of the ulnar nerve during arthroscopic repair of triangular fibrocartilage complex injuries: Cadaver study and preliminary clinical results

The ulnar-sided approach for arthroscopic peripheral triangular fibrocartilage complex (TFCC) repair may be associated with injury to the dorsal branch of the ulnar nerve (DBUN). The goal of this study was to develop a small incision to help minimize DBUN injury. Ten cadaveric upper limbs were used...

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Veröffentlicht in:Hand surgery and rehabilitation 2019-12, Vol.38 (6), p.381-385
Hauptverfasser: Yu, B.F., Yin, H.W., Qiu, Y.Q., Shen, Y.D., Gu, Y.D., Xu, W.D.
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Sprache:eng
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Zusammenfassung:The ulnar-sided approach for arthroscopic peripheral triangular fibrocartilage complex (TFCC) repair may be associated with injury to the dorsal branch of the ulnar nerve (DBUN). The goal of this study was to develop a small incision to help minimize DBUN injury. Ten cadaveric upper limbs were used to measure the anatomic parameters of the DBUN. Based on these measured anatomical relationships, a 20 mm longitudinal incision with the ulnar styloid process as the midpoint was designed to explore and protect the DBUN. Three additional cadaveric upper limbs were used to test the feasibility of this method. Then this method was applied in 15 patients with TFCC injury (IB type). In 10 cadavers, the DBUN was located volar to the ulnar styloid process. The mean linear distance between the DBUN and the ulnar styloid process was 8.04 mm (range: 7.02–8.82mm) in the transverse-volar direction and 13.78 mm (range: 11.06–16.02mm) in the longitudinal-distal volar direction. In three additional cadavers, the DBUN was successfully explored and retracted with this incision, creating a safer space for passing sutures and tying knots. This modified method was used successfully in 15 patients, and the DBUN was protected during surgery. There were no complications, and most importantly, no injuries to the DBUN at the 6-month follow-up visit. Therefore, we recommend that a 20 mm longitudinal incision with the ulnar styloid process as the midpoint be made prior to passing sutures during the arthroscopic repair of TFCC tears to avoid injuring the various branches of the DBUN. L’abord ulnaire pour la réparation arthroscopique des lésions périphériques du complexe fibrocartilagineux triangulaire (TFCC) peut être responsable de lésions du rameau dorsal du nerf ulnaire (RDNU). Le but de cette étude était d’utiliser une petite incision pour minimiser les blessures du RDNU. Dix membres supérieurs de cadavres ont été employés pour mesurer les paramètres anatomiques du DBUN. Selon les rapports anatomiques mesurés, une incision longitudinale de 20mm avec le processus styloïde ulnaire comme point médian a été conçue pour explorer et protéger le RDNU. Trois membres supérieurs de cadavres supplémentaires ont été employés pour tester la faisabilité de cette méthode. Puis cette méthode a été utilisée chez 15 patients atteints de lésions du TFCC (type IB). Chez 10 cadavres, le RDNU a été localisé en avant du processus styloïde ulnaire, et la distance linéaire moyenne entre le DBUN et le processu
ISSN:2468-1229
2468-1210
DOI:10.1016/j.hansur.2019.09.008