OKOJ, Volume 13, No. 12

Management of Injuries to the Triangular Fibrocartilage Complex

The triangular fibrocartilage complex (TFCC) spans and supports the distal radioulnar joint and ulnocarpal articulations. The components of the TFCC include the volar and dorsal radioulnar ligaments, articular disc, sheath of the extensor carpi ulnaris tendon, ulnocarpal ligaments, and meniscus homologue. The accurate diagnosis of injuries to the TFCC depends on a combination of physical examination and imaging modalities. Arthroscopy plays a role in both the diagnosis and treatment of injuries to the TFCC. The management of acute and chronic injuries to the TFCC ranges from nonsurgical treatment to open repair. In cases of severe degenerative disease, ulnar resection may be indicated. This article is a review of the pertinent pathophysiology, diagnosis, and management of injuries to the TFCC with a focus on arthroscopic and open surgical techniques.

    • Keywords:
    • triangular fibrocartilage complex

    • TFCC

    • wrist arthroscopy

    • TFCC injury

    • TFCC repair

    • Subspecialty:
    • Hand and Wrist

Palpation Versus Ultrasound-Guided Injection of Corticosteroid for Plantar Fasciitis

We conducted a study to compare the effect of palpation-guided with ultrasound-guided corticosteroid injection for reducing the pain of plantar fasciitis. We recruited for the study 42 patients with plantar fasciitis, of whom 20 had palpation-guided (Group A) and 22 had ultrasound-guided (Group B) corticosteroid injection. We used a Visual Analog Scale (VAS) and the Planter Fasciitis Pain and Disability Scale (PFPS) to assess the pain in both groups during a period of 1 year after the injection of corticosteroid under both types of guidance and at different time points within this study period. Pain from plantar fasciitis as measured with the VAS and the PFPS was decreased in both study groups after 1 year of treatment (P < 0.0001). Patients in Group B had lower VAS scores than those in Group A at 2-week, 6-week, 3-month, and 6-month follow-up intervals. Pain as reflected by the VAS was significantly higher in Group A as compared with Group B at all-time points after injection, except at 1 year. Pain as measured by the PFPS was significantly less severe in Group B at all time points except 6 months and 1 year. The study indicates that ultrasound-guided corticosteroid injection has greater efficacy than palpation-guided corticosteroid injection in reducing the pain of plantar fasciitis after 6 months of treatment.

    • Keywords:
    • ultrasound

    • plantar fasciitis

    • visual analog scale

    • corticosteroid injection

    • Subspecialty:
    • Foot and Ankle

Radiation-associated Fractures

Radiation-associated fractures are insufficiency fractures of bone in areas that have been irradiated. The injury to the bone and soft-tissue envelope that occur with such fractures can be difficult to treat and may require multiple surgeries before an acceptable result is achieved. A wide range of management options exist for radiation-associated fractures, including observation, internal fixation, endoprosthetic reconstruction, and amputation. This article summarizes the literature on management options for radiation-associated fractures and is intended to assist decision making about the management of these problematic fractures, with the goal of minimizing their complications and eliminating unnecessary multiple surgeries for them.

    • Keywords:
    • radiation therapy

    • pathologic fracture

    • nonunion

    • Subspecialty:
    • Musculoskeletal Oncology

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