0:01

Type one C lesion is the distal avulsion.

0:05

You can see what it looks like now.

0:07

This is an uncommon lesion.

0:09

I only have a couple of cases to show you.

0:11

This one is showing you distal detachment of the ul,

0:15

no lunate and ul, no tri ral ligaments

0:19

with a radial carpal arthrogram.

0:21

This opens up the opening.

0:23

The normal opening is now too wide

0:25

and you will fill the pisiform triquetral car

0:28

compartment as shown here.

0:31

And then we had one in a cadaver, one of our cadavers.

0:34

This was a partial tear of the distal aspect of the

0:40

ate, uh, uh, TriCal ligament.

0:42

You can see it here. And by the way,

0:44

this patient did have a problem with a piso ate ligament.

0:50

The 1D lesion is a radial evulsion

0:53

and this has been classified into four types

0:56

depending upon whether or not it is soft tissue or bone.

1:00

And whether or not it involves only the triangular

1:03

fibrocartilage disc, or it may involve one

1:07

or both of the radial ulnar ligaments.

1:10

This is a more significant lesion when the radial ulnar

1:14

ligaments are involved.

1:16

I'm gonna show you a couple of examples.

1:19

This is interesting.

1:20

It's a Madeline Light deformity

1:22

with an acute radial avulsion of the disc.

1:26

So here is the radiograph, there is the avulsion.

1:29

It was involving mainly the disc right at the

1:33

radial attachment.

1:34

Obviously there's a fracture, you can see it here.

1:37

It doesn't involve the radi nerve ligaments.

1:40

It's located more centrally.

1:43

So this is a 1D lesion. And here's another one.

1:48

So here the disc has been pulled away from

1:50

the radius itself.

1:52

Okay, that's 1D.

1:55

And involved the V lar radio neuro ligament as well,

1:59

which has also been torn away from the radius communication

2:03

between the radiocarpal

2:04

and distal radio, the compartments with the involvement

2:08

of the radio neuro ligament.

2:09

This is a more significant problem.

2:12

Now we're gonna finish up in the last, uh,

2:15

well probably eight to 10 minutes

2:17

or so, talking about some other lesions

2:21

described in the recent literature

2:23

that do not fit into the Palmer classification.

2:27

This is a sagittal drawing that I tried to make.

2:30

This is a sagittal orbi section in a cadaver.

2:35

Most of the Palmer lesions, I'm not showing you the 1D

2:39

'cause I don't have The radius here are located on the

2:42

vola aspect.

2:44

So here's a Palmer one, A lesion.

2:46

Here's a Palmer one B lesion.

2:48

This is the volar ulnar triquetral ligament.

2:51

This is the disc. And here is the Palmer one C lesion.