Kakar, Sanj

The use of arthroscopy of the hand and wrist has recently increased sharply in the elective setting and this, not surprisingly, has been followed by an increasing use in the trauma setting. Advocates for the use of arthroscopy in these patients cite the improved assessment of the displacement and reduction of fractures and the early diagnosis of associated injuries, while others temper this with concerns about increased operating time and possible complications. The data relating to patient-reported benefits and costs are limited. The aim of this review was to discuss the current available literature for the use of arthroscopy in the management of injuries of the hand and wrist.Cite this article: Bone Joint J 2025;107-B(3):291–295.

Abstract Total wrist arthroplasty (TWA) is a motion-preserving treatment option for wrist arthritis. High-precision measurement methods for implant migration such as computed tomography motion-analysis (CTMA) can potentially detect poor implant fixation. The aim of this pilot study was to assess CTMA as a complementary method to diagnose aseptic loosening of TWA. Three patients with a TWA and wrist pain during activity underwent induced displacement CT (CTMA) with alternated provocations as a complement to plain radiographs. Two of the three patients had displacement of the carpal component on CTMA. The radial component was stable in all cases. The tool was adapted to clinical routine use. CT motion-analysis could be a valuable adjunct to plain radiographs in assessing component loosening in TWA.

Injury to the triangular fibrocartilage complex (TFCC) may result in ulnar wrist pain with or without instability. One component of the TFCC, the radioulnar ligaments, serve as the primary soft-tissue stabilizer of the distal radioulnar joint (DRUJ). Tears or avulsions of its proximal, foveal attachment are thought to be associated with instability of the DRUJ, most noticed during loaded pronosupination. In the absence of detectable instability, injury of the foveal insertion of the radioulnar ligaments may be overlooked. While advanced imaging techniques such as MRI and radiocarpal arthroscopy are well-suited for diagnosing central and distal TFCC tears, partial and complete foveal tears without instability may be missed without a high degree of suspicion. While technically challenging, DRUJ arthroscopy provides the most accurate method of detecting foveal abnormalities. In this annotation the spectrum of foveal injuries is discussed and a modified classification scheme is proposed. Cite this article: Bone Joint J 2023;105-B(1):5–10.