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