1. 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

2. 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

3. 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:
Melone CP Jr, Nathan R: Traumatic disruption of the triangular fibrocartilage complex: Pathoanatomy. Clin Orthop (275):65-73, 1992.

4. TFCC associated with distal radius fractures
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 year follow-up of arthroscopically diagnosed but untreated injuries. J Hand Surg Am. 2012 Aug;37(8): doi: /j.jhsa

5. 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

6. Methodology Exclusion criteria Delayed fixations requiring osteotomy
Secondary surgeries
Fixations requiring external fixation

7. 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

8. Results - Epidemiology
Age
Mean: 49.6
Range: 27-73
25%
75%

9. Mechanism

10. 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

11. Pre-operative parameters
4 had DRUJ widening on pre-operative xrays

12. Results: Surgical details
67%

13. Brian D. Adams. Green’s Operative Hand Surgery, 5th ed.

14. Post-operative: Rehabilitaion
External splint (Munster) or internal (k-wires) for 6 weeks
Interval mobilisation exercises except supination and pronation for 6 weeks

15. 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

16. 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

17. Complications Ulnar sided pain – 3 (2 resolved after 6 months)
Instability symptoms – 1 (required reconstruction)
Ulnar nerve symptoms – 0
Infection – 0

18. 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