Results of 12 Open Triangular Fibrocartilage Repair associated with
radius fracture
Kevin Wong JH, Sreedharan S, Yong FC, Teoh LC, Chew WY
Tan Tock Seng HospitalSingapore
Hand & Microsurgery sectionDepartment of Orthopaedics
Introduction
• TFCC tears associated with radius fractures are common and frequently missed
• Untreated TFCC tears can lead to debilitating ulnar sided pain and destabilizing symptoms
• TFCC can be addressed at the same time during the radius fixation• We present our results of acute TFCC open repair in association with
a radius fixation
TFCC tears without ulnar styloid fracture• 10 cadaveric specimens DRUJ distracted to failure• No ulnar styloid fractures
Adams BD, Samani JE, et al: Triangular fibrocartilage injury: a laboratory model. J Hand Surg [Am] 1996; 21:189-193.
TFCC associated with distal radius fractures• 1995-1997• 51 patients with displaced distal radius fractures had wrist
arthroscopy done• 43 had complete/partial tears of TFCC• 13-15 years after the injury
• 17/38 lax DRUJ
Mrkonjic A, Geijer M, Lindau T, Tägil M. The natural course of traumatic triangular fibrocartilage complex tears in distal radial fractures: a 13-15 year follow-up of arthroscopically diagnosed but untreated injuries. J Hand
Surg Am. 2012 Aug;37(8):1555-60. doi: 10.1016/j.jhsa.2012.05.032.
Methodology
• Retrospective study• All open TFCC repair with radius fixation from July 2009-April 2012• Data from clinical records and database• Data analysis with SPSS v19.0
Methodology
Exclusion criteria• Delayed fixations requiring osteotomy• Secondary surgeries• Fixations requiring external fixation
Results
• From July 2009-April 2012, 12 cases met the inclusion criteria.• 1 patient had concomitant facial fracture• 2 had ulnar head fractures• All 12 cases tears were class 1B tears (Palmar classification) without
ulnar styloid fracture
Results - Epidemiology
Age
Mean: 49.6
Range: 27-7325%
75%
Mechanism
Results: Injury patterns/time
• 7 close fractures• 5 open fractures (Gustilo 1)• Time to surgery
• Mean 1.3 days• Range (0 – 7 days)• Open fractures < 1 day
Pre-operative parameters
• 4 had DRUJ widening on pre-operative xrays
Results: Surgical details
67%
Brian D. Adams. Green’s Operative Hand Surgery, 5th ed.
Post-operative: Rehabilitaion
• External splint (Munster) or internal (k-wires) for 6 weeks• Interval mobilisation exercises except supination and pronation for 6
weeks
Follow up period
• 1, 3, 6 weeks• 3, 6, 12, 24, 36 months
• Mean follow up 14 months
6 months 12 months 24 months 36 months
4 5 2 1
Results: Clinical outcome
• Mean grip strength 74.3% of uninjured side• 1 had laxity on examination
Palmar flexion
Dorsi flexion
Supination Pronation Radial deviation
Ulnar deviation
Mean Range of Motion(Range)
43°
(30°-50°)
55°
(45°-60°)
80°
(50°-90°)
63°
(10°-90°)
14°
(0°-25°)
28°
(10°-30°)
Complications
• Ulnar sided pain – 3 (2 resolved after 6 months)• Instability symptoms – 1 (required reconstruction)• Ulnar nerve symptoms – 0• Infection – 0
Summary
• TFCC tears are commonly associated with radius fractures and are commonly missed especially in distal radius fractures
• Acute repair in the same setting with fixation of the radius fracture will allow good stability
