Improved Outside-In Suture through the Joint Capsule to Repair the Palmer I-B Triangular Fibrocartilage Complex Superficial Injury

Abstract

Background. The treatment of type I-B triangular fibrocartilage complex superficial injury is always a challenge to orthopedists. The traditional outside-in suture method often causes a risk of nervous irritation. We designed a modified outside-in suture through the joint capsule to repair the Palmer I-B triangular fibrocartilage complex superficial injury. Methods. From December 2014 to December 2018, we retrospectively collected the medical records of 18 patients in our hospital who used the modified outside-in suture through the joint capsule to repair type I-B triangular fibrocartilage complex superficial injury. Among them, there were 12 males and 6 females, with an average age of 36.2 years. There were 6 cases on the left side and 12 cases on the right side. Record the healing time of all patients after surgery and the occurrence of related complications, and record the pain visual analogue scale (VAS), grip strength, wrist flexion and extension, radioulnar deviation and forearm rotation range of motion, modified Mayo wrist joint function score, and disability of arm-shoulder-hand (DASH) score before operation and at the last follow-up. Results. One patient was lost to follow-up, and a total of 17 patients received the final follow-up. Patients were followed up for 24 to 36 months, with an average of $29.6\pm 3.0$ months. No wound infection, nerve damage, or irritation occurred after the operation. At the last follow-up, 15 cases of wrist pain disappeared completely, and 2 cases had mild discomfort during exercise. At the last follow-up, VAS decreased from $3.8\pm 0.7$ points before operation to $0.8\pm 0.7$ points ( $P<0.05$ ); grip strength increased from $15.1\pm 3.1$  kg before operation to $23.2\pm 1.5$  kg ( $P<0.05$ ); wrist flexion and extension, radioulnar deflection, and forearm rotational mobility increased from $116.3\pm 2.2$ °, $37.0\pm 3.5$ °, and $141.6\pm 2.2$ ° before operation to $117.2\pm 2.5$ ° ( $P<0.05$ ), $38.9\pm 3.0$ ° ( $P<0.05$ ), and $142.4\pm 1.9$ ° ( $P<0.05$ ), respectively; the modified Mayo wrist joint function score increased from $66.1\pm 3.6$ points to $82.5\pm 3.9$ points ( $P<0.05$ ), of which 10 cases were excellent, 5 cases were good, 2 cases were fair, and the excellent and good rate was 88.2%; DASH score improved from $37.0\pm 5.7$ points preoperatively to $8.0\pm 2.5$ points ( $P<0.05$ ). Conclusion. The modified outside-in suture through the joint capsule to repair the superficial injury of Palmer I-B triangular fibrocartilage complex has a good clinical effect and is worthy of clinical widespread promotion.