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 Hospital Singapore Hand & Microsurgery section Department 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. Melone CP Jr, Nathan R: Traumatic disruption of the triangular fibrocartilage complex: Pathoanatomy. Clin Orthop (275):65-73, 1992.

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 A class 1B injury is a partial or complete avulsion of the TFCC from its ulnar attachments

Results - Epidemiology Age Mean: 49.6 Range: 27-73 25% 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 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°) Mean grip strength 74.3% of uninjured side 1 had laxity on examination

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