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Triangular fibrocartilage complex injuries are one of the most common causes of ulnar-sided wrist pain. Although pain and discomfort may improve with simple immobilization for a short period of time, a significant number of patients eventually require surgical intervention. The purpose of this study was to investigate the incidence of surgical intervention on patients with a clinical diagnosis of a triangular fibrocartilage complex injury. A retrospective chart review was performed to identify patients with ulnar-sided wrist pain identified with the appropriate ICD-9 code from September 2005 to September 2007. All patients were evaluated and treated by a board-certified, fellowship-trained hand surgeon. Any patients with associated pathology were excluded from the study. All patients were initially treated with a minimum of 4 weeks of either a volar wrist splint worn all the time or a short-arm cast. Magnetic resonance images were obtained on patients without symptomatic relief, and in these cases, surgical arthroscopy was performed. Of the 84 patients identified, 36 patients required surgical intervention. All 36 patients had evidence of triangular fibrocartilage complex injury during arthroscopy. All patients had symptomatic improvement postoperatively. The use of short-arm cast versus a splint did not affect the rate of surgical intervention (P=.38). Among the patients with clinical diagnosis of triangular fibrocartilage complex injury, the rate of surgical intervention required after a minimum 4 weeks of immobilization was 43%. The use of a short-arm cast or volar wrist splint did not affect the rate of surgical intervention., (Copyright 2010, SLACK Incorporated.)

Fourteen adult burials in a large (N = 224) prehistoric central California cemetery (CA-SCL-674) lack forearm bones. Twelve of these otherwise well-articulated primary interments have distal humeri bearing cutmarks with a distribution like that seen in fur seals butchered by Native Californians. Most of the burials with missing forearms are young adult males, a demographic profile that differs significantly from the full sample. Three of these males show evidence of perimortem trauma in addition to forearm amputation. Drilled and polished human radii and ulnae were recovered from the CA-SCL-674 cemetery in archaeological contexts separate from burials with missing forearms. A warfare-related trophy-taking practice is strongly suggested by these bioarchaeological data. Based on these data, it seems likely that 20% (N = 10) or more of the adult males (N = 59) in this population were victims of violence. Evidence of perimortem violence was much less common among women, with only about 2% (N = 2) of adult females (N = 86) subjected to trophy-taking. Examination of museum collections produced further evidence for perimortem forearm amputation among the Native American inhabitants of this area during the transition between the Early and Middle periods. The emergence of more hierarchical social systems during this period may have fostered warfare-related trophy-taking as a symbolic tool for enhancing the power and prestige of individuals within competing social groups., ((c) 2005 Wiley-Liss, Inc.)