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ULNAR-SIDE WRIST INJURIES
(see also Chapter 16)
The distal radio-ulnar joint is often injured with a radial fracture; it can also be damaged in isolation, particularly after hyperpronation. The triangular fibrocartilage complex (TFCC) can be torn, the ulnar styloid avulsed or the articular surfaces of the ulnocarpal joint or distal radio-ulnar joint damaged.
Clinical features
There is tenderness over the distal radio-ulnar joint and pain on rotation of the forearm. The distal ulna may be unstable; the piano-key sign is elicited by holding the patient’s forearm pronated and pushing
sharply forwards on the head of the ulna.
Imaging and arthroscopy
A lateral x-ray in pronation and supination shows incongruity of the distal radio-ulnar joint. The anteroposterior view may show an avulsed ulnar styloid. Arthrography, MRI and arthroscopy may be needed to confirm the diagnosis.
Treatment
Instability usually resolves if the arm is held in supination for 6 weeks; occasionally a K-wire is needed to maintain the reduction. If the dislocation is irreducible, this may be due to trapped soft tissue, which
will have to be removed. Chronic instability may require reconstructive surgery.
A TFCC tear should be repaired and the ulnocarpal capsule reefed. A displaced fracture at the base of the ulnar styloid, if painful or associated with instability of the radio-ulnar joint, should be fixed with a small screw.
---from 《Apley’s System of Orthopaedics and Fractures》
重點詞彙整理：
hyperpronation 極度旋前（醫學）
elicit /ɪˈlɪsɪt/vt. 抽出，引出；引起
supination /,sju:pi'neiʃən/n. 旋後；反掌姿勢
incongruity /ˌɪnkənˈɡruːəti/n. 不協調；不一致；不適宜
Arthrography /ɑ:'θrɔɡrəfi/n. [特醫] 關節照相術；[特醫] 關節攝影術
arthroscopy /ɑr'θrɑskəpi/n. 關節鏡檢查；關節內視鏡檢查法
irreducible, /ˌɪrɪˈduːsəbl/adj. [數] 不可約的；不能削減的；不能復歸的
reef /riːf/n. 暗礁；[地質] 礦脈；收帆vt. 收帆；縮帆
百度翻譯：
尺側腕關節損傷
（另見第16章）
橈尺骨遠端關節常因橈骨骨折而受傷，也可單獨受損，尤其是過度旋前後。三角纖維軟骨複合體（TFCC）可撕裂、尺骨莖突撕脫、尺側腕關節或橈尺遠側關節面損傷。
臨床特徵
橈尺關節遠端有壓痛，前臂旋轉時疼痛。尺骨遠端可能不穩定；保持患者前臂內旋並推壓可誘發鋼琴鍵徵
在尺骨的頭部急速向前移動。
影像學和關節鏡檢查
旋前和旋後的側位x線片顯示橈尺關節遠端不協調。前後視圖顯示尺骨莖突撕裂。可能需要關節鏡、核磁共振成像和關節鏡檢查來確認診斷。
治療
如果手臂在仰臥位保持6周，不穩定性通常會得到解決；偶爾需要使用K形鋼絲維持復位。如果脫位是無法復位的，這可能是由於軟組織被困
必須移除。慢性不穩定可能需要重建手術。
TFCC撕裂應修復，尺骨腕關節囊重瓣。尺骨莖突基底部移位骨折，如果疼痛或伴有橈尺關節不穩，應使用小螺釘固定。
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