Conceptos actuales en el manejo de lesiones traumáticas del fibrocartílago triangular
DOI:
https://doi.org/10.63403/re.v32i3.427Palabras clave:
Articulación radiocubital distal (RCD), complejo fibrocartilaginoso triangular (CFCT), inestabilidad de la articulación radiocubital distal, reparación artroscópica del CFCTResumen
Las lesiones alrededor de la articulación radiocubital distal (RCD) no son infrecuentes, y pueden involucrar solo a los tejidos blandos, especialmente el complejo fibrocartílago triangular (CFCT), o asociarse a fracturas del radio distal, fracturas del estiloides cubital, o fracturas-luxaciones de Galeazzi o Essex-Lopresti. Un conocimiento adecuado de la compleja anatomía y biomecánica del CFCT y la articulación RCD es crucial para comprender las opciones de tratamiento y lograr restaurar la estabilidad y la rotación adecuada, evitando, en el futuro, la necesidad de procedimientos secundarios o de rescate. No reconocer, reducir anatómicamente, reparar y/o estabilizar estas lesiones puede llevar a la inestabilidad crónica, rigidez, y/o artritis dolorosa.
El propósito de esta revisión fue ofrecer una actualización integral sobre la anatomía funcional, el enfoque diagnóstico y las opciones terapéuticas disponibles para el manejo de las lesiones del CFCT, con especial énfasis en la evaluación clínico-radiológica, su clasificación, y su abordaje conservador y quirúrgico.
Nivel de evidencia: V. Revisión Narrativa
Citas
Kleinman WB. Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years. J Hand Surg Am. 2007 Sep;32(7):1086-1106. doi: https://doi.org/10.1016/j.jhsa.2007.06.014 DOI: https://doi.org/10.1016/j.jhsa.2007.06.014
Hagert E, Hagert CG. Understanding stability of the distal radioulnar joint through an understanding of its anatomy. Hand Clin. 2010 Nov;26(4):459-466. doi: https://doi.org/10.1016/j.hcl.2010.05.002. DOI: https://doi.org/10.1016/j.hcl.2010.05.002
Haugstvedt JR, Berger RA, Nakamura T, Neale P, Berglund L, An KN. Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg Am. 2006 Mar;31(3):445-451. doi: https://doi.org/10.1016/j.jhsa.2005.11.008. DOI: https://doi.org/10.1016/j.jhsa.2005.11.008
Stuart PR, Berger RA, Linscheid RL, An KN. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg Am. 2000 Jul;25(4):689-699. doi: https://doi.org/10.1053/jhsu.2000.9418. DOI: https://doi.org/10.1053/jhsu.2000.9418
Linscheid RL, Dobyns JH. Dynamic carpal stability. Keio J Med. 2002 Sep;51(3):140-147. doi: https://doi.org/10.2302/kjm.51.140. DOI: https://doi.org/10.2302/kjm.51.140
Hagert CG. Distal radius fracture and the distal radioulnar joint--anatomical considerations. Handchir Mikrochir Plast Chir. 1994 Jan;26(1):22-26
Hagert E, Andersson JK. Anatomy of the distal radioulnar joint and ulnocarpal complex. En: Kakar S, Yao J (eds.). ASSH Surgical anatomy: ulnar-sided wrist disorders. Chicago, American Society for Surgery of the Hand, 2022. pp. 2–15.
Bednar MS, Arnoczky SP, Weiland AJ. The microvasculature of the triangular fibrocartilage complex: its clinical significance. J Hand Surg Am. 1991 Nov;16(6):1101-1105. doi: https://doi.org/10.1016/s0363-5023(10)80074-7. DOI: https://doi.org/10.1016/S0363-5023(10)80074-7
Rein S, Semisch M, Garcia-Elias M, Lluch A, Zwipp H, Hagert E. Immunohistochemical mapping of sensory nerve endings in the human Triangular fibrocartilage complex. Clin Orthop Relat Res. 2015 Oct;473(10):3245-3253. doi: https://doi.org/10.1007/s11999-015-4357-z. DOI: https://doi.org/10.1007/s11999-015-4357-z
Hagert E, Rein S. Wrist proprioception-an update on scientific insights and clinical implications in rehabilitation of the wrist. J Hand Ther. 2024 Apr-Jun;37(2):257-268. doi: https://doi.org/10.1016/j.jht.2023.09.010. DOI: https://doi.org/10.1016/j.jht.2023.09.010
Henry MH. Management of acute triangular fibrocartilage complex injury of the wrist. J Am Acad Orthop Surg. 2008 Jun;16(6):320-329. doi: https://doi.org/10.5435/00124635-200806000-00004. DOI: https://doi.org/10.5435/00124635-200806000-00004
Minhas S, Kakar S, Wall LB, Goldfarb CA. Foveal triangular fibrocartilage complex tears: recognition of a combined tear pattern. J Hand Surg Am. 2023 Oct;48(10):1063.e1-1063.e6. doi: https://doi.org/10.1016/j.jhsa.2022.03.010. DOI: https://doi.org/10.1016/j.jhsa.2022.03.010
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 Apr;32(4):438-444. doi: https://doi.org/10.1016/j.jhsa.2007.01.022. DOI: https://doi.org/10.1016/j.jhsa.2007.01.022
Moriya T, Aoki M, Iba K, Ozasa Y, Wada T, Yamashita T. Effect of triangular ligament tears on distal radioulnar joint instability and evaluation of three clinical tests: a biomechanical study. J Hand Surg Eur Vol. 2009 Apr;34(2):219-223. doi: https://doi.org/10.1177/1753193408098482. DOI: https://doi.org/10.1177/1753193408098482
May MM, Lawton JN, Blazar PE. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg Am. 2002 Nov;27(6):965-971. doi: https://doi.org/10.1053/jhsu.2002.36525. DOI: https://doi.org/10.1053/jhsu.2002.36525
Souer JS, Ring D, Matschke S, Audige L, Marent-Huber M, Jupiter JB, et al. Effect of an unrepaired fracture of the ulnar styloid base on outcome after plate-and-screw fixation of a distal radial fracture. J Bone Joint Surg Am. 2009 Apr;91(4):830-838. doi: https://doi.org/10.2106/JBJS.H.00345. DOI: https://doi.org/10.2106/JBJS.H.00345
Park MJ, Kim JP. Reliability and normal values of various computed tomography methods for quantifying distal radioulnar joint translation. J Bone Joint Surg Am. 2008 Jan;90(1):145-153. doi: https://doi.org/10.2106/JBJS.F.01603. DOI: https://doi.org/10.2106/JBJS.F.01603
Mino DE, PalMino DE, Palmer AK, Levinsohn EM. The role of radiography and computerized tomography in the diagnosis of subluxation and dislocation of the distal radioulnar joint. J Hand Surg Am. 1983 Jan;8(1):23-31. doi: https://doi.org/10.1016/s0363-5023(83)80046-x. DOI: https://doi.org/10.1016/S0363-5023(83)80046-X
Magee T. Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol. 2009 Jan;192(1):80-85. doi: https://doi.org/10.2214/AJR.08.1089. DOI: https://doi.org/10.2214/AJR.08.1089
Haugstvedt JR, Søreide E. Arthroscopic management of triangular fibrocartilage complex peripheral injury. Hand Clin. 2017 Nov;33(4):607-618. doi: https://doi.org/10.1016/j.hcl.2017.06.005. DOI: https://doi.org/10.1016/j.hcl.2017.06.005
Atzei A. New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability. J Hand Surg Eur Vol. 2009 Oct;34(5):582-591. doi: https://doi.org/10.1177/1753193409100120. DOI: https://doi.org/10.1177/1753193409100120
Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist--anatomy and function. J Hand Surg Am. 1981 Mar;6(2):153-162. doi: https://doi.org/10.1016/s0363-5023(81)80170-0. DOI: https://doi.org/10.1016/S0363-5023(81)80170-0
Atzei A, Luchetti R. Foveal TFCC tear classification and treatment. Hand Clin. 2011 Aug;27(3):263-272. doi: https://doi.org/10.1016/j.hcl.2011.05.014. DOI: https://doi.org/10.1016/j.hcl.2011.05.014
Herzberg G, Burnier M, Ly L, Nakamura T, Piñal FD, Atzei A. A new arthroscopic classification of triangular fibrocartilage complex disorders. J Wrist Surg. 2023 Aug 7;13(1):2-8. doi: https://doi.org/10.1055/s-0043-1769908. DOI: https://doi.org/10.1055/s-0043-1769908
Moritomo H, Masatomi T, Murase T, Miyake J, Okada K, Yoshikawa H. Open repair of foveal avulsion of the triangular fibrocartilage complex and comparison by types of injury mechanism. J Hand Surg Am. 2010 Dec;35(12):1955-1963. doi: https://doi.org/10.1016/j.jhsa.2010.07.031. DOI: https://doi.org/10.1016/j.jhsa.2010.07.031
Park MJ, Jagadish A, Yao J. The rate of triangular fibrocartilage injuries requiring surgical intervention. Orthopedics. 2010 Nov 2;33(11):806. doi: https://doi.org/10.3928/01477447-20100924-03. DOI: https://doi.org/10.3928/01477447-20100924-03
Dailey SW, Palmer AK. The role of arthroscopy in the evaluation and treatment of triangular fibrocartilage complex injuries in athletes. Hand Clin. 2000 Aug;16(3):461-476. DOI: https://doi.org/10.1016/S0749-0712(21)00587-4
Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am. 2002 Mar;27(2):243-251. doi: https://doi.org/10.1053/jhsu.2002.31731. DOI: https://doi.org/10.1053/jhsu.2002.31731
Aita MA, Mallozi RC, Ozaki W, Ikeuti DH, Consoni DAP, Ruggiero GM. Ligamentous reconstruction of the interosseous membrane of the forearm in the treatment of instability of the distal radioulnar joint. Rev Bras Ortop. 2018 Feb;53(2):184-191. doi: https://doi.org/10.1016/j.rboe.2018.02.010. DOI: https://doi.org/10.1016/j.rboe.2018.02.010
Atzei A. DRUJ instability: arthroscopic ligament reconstruction. En: del Piñal F, Mathoulin C, Luchetti R (eds). Arthroscopic management of ulnar pain. Berlin, Springer, 2012. pp147–160. doi: https://doi.org/10.1007/978-3-642-30544-3_11. DOI: https://doi.org/10.1007/978-3-642-30544-3_11
Tse WL, Lau SW, Wong WY, Cheng HS, Chow CS, Ho PC, et al. Arthroscopic reconstruction of triangular fibrocartilage complex (TFCC) with tendon graft for chronic DRUJ instability. Injury. 2013 Mar;44(3):386-390. doi: https://doi.org/10.1016/j.injury.2013.01.009. DOI: https://doi.org/10.1016/j.injury.2013.01.009
Edgerton MT, Kollmorgen RC. A novel all-inside arthroscopic technique for radial-sided triangular fibrocartilage complex tears: a case report and review of literature. Hand (N Y). 2017 Sep;12(5):NP166-NP169. doi: https://doi.org/10.1177/1558944717715138. DOI: https://doi.org/10.1177/1558944717715138
Liu EH, Suen K, Tham SK, Ek ET. Surgical repair of triangular fibrocartilage complex tears: a systematic review. J Wrist Surg. 2021 Feb;10(1):70-83. doi: https://doi.org/10.1055/s-0040-1718913. DOI: https://doi.org/10.1055/s-0040-1718913
Andersson JK, Åhlén M, Andernord D. Open versus arthroscopic repair of the triangular fibrocartilage complex: a systematic review. J Exp Orthop. 2018 Mar 13;5(1):6. doi: https://doi.org/10.1186/s40634-018-0120-1. DOI: https://doi.org/10.1186/s40634-018-0120-1
Robba V, Fowler A, Karantana A, Grindlay D, Lindau T. Open versus arthroscopic repair of 1B ulnar-sided triangular fibrocartilage complex tears: a systematic review. Hand (N Y). 2020 Jul;15(4):456-464. doi: https://doi.org/10.1177/1558944718815244. DOI: https://doi.org/10.1177/1558944718815244
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