Dorsal Tear of Triangular Fibrocartilage Complex: Clinical Features and Treatment

Abstract

The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ) and a load absorber of the ulnocarpal (UC) joint. A TFCC injury is also recognized as a major cause of ulnar-sided wrist pain. Palmer has classified traumatic TFCC tears into four subtypes depending on the location of the tear. 1 As more recent studies have clarified the anatomical structure of TFCC 2,3 and through the use of wrist arthroscopy, it has become evident that not all of the TFCC tear patterns are included in Palmer original classification.A dorsal tear of the TFCC was first clearly described by Estrella et al in 2007 4 as being located in the area between the extensor carpi ulnaris (ECU) subsheath and the extensor digiti minimi (EDM)-a precarious site for tear. Abe et al reported AbstractBackground Several different triangular fibrocartilage complex (TFCC) tear patterns have been classified through the use of wrist arthroscopy. A tear of the dorsal aspect of the TFCC has been previously reported, but it is not included in Palmer original classification. Our purpose was to describe this type of tear pattern along with the clinical presentation. Methods An isolated dorsal TFCC tear was encountered in seven wrists of six patients (three men and three women; average age was 31 years). All patients were evaluated by physical exam, X-ray, plain axial computed tomography with pronation, neutral and supination position, magnetic resonance imaging (MRI) with coronal, sagittal, and axial section and arthroscopy. Results The clinical findings varied and included the following: tenderness at the dorsoulnar aspect of the wrist was positive in all wrists, fovea sign was positive in five wrists, and tenderness at the dorsal aspect of the distal radioulnar joint was present in one wrist. Pain with forearm rotation was positive in all wrists. The ulnar head ballottement test induced pain in all wrists, whereas dorsal instability of the ulnar head was present in one wrist with this test. The ulnocarpal stress test was positive in five wrists. Axial and sagittal images on MRI revealed the dorsal tear in five wrists. All wrists were treated with an arthroscopic capsular repair. The final functional outcome at an average follow-up of 16.1 months was four excellent and one good wrist according to the modified Mayo wrist score. Conclusions The aim of this article is to describe our experiences with tears involving the dorsal aspect of the TFCC, which may be misdiagnosed if the surgeon is not cognizant of this injury. Type of study/level of evidence Diagnostic/level IV

Analyses of fracture line distribution in intra-articular distal radius fractures

“…According to the fracture mapping analyses, the fracture lines were observed to be widely and randomly distributed in this area, accompanied with the free bone fragments. As the triangular fibrocartilage complex (TFCC) was considered as the major ligamentous stabilizer of the distal radioulnar joint [10], more attention should be paid for restoring the stability of TFCC, which is dependent on the distribution of the fracture lines at the sigmoid notch, during the fracture reduction and fixation.…”

Advances in the Repair of Palmer type IB TFCC Injuries With Wrist Arthroscopy

“…After an injury, repairable areas can be surgically repaired because of adequate blood supply and strong healing ability. In contrast, nonrepairable areas are surgically debrided because of a lack of blood supply 9,10 …”

Chronologic and Geographic Trends of Triangular Fibrocartilage Complex Repair

“…21,46 All four articles were published in Asia (Figure 8). The volar TFCC tears were repaired the same way as ulnar-side TFCC repairs (open or outside-in technique).…”

“…37,45 In both articles discussing dorsal tears, the outside-in technique was used. 21,46 Dorsal tears of the TFCC are not included in the original Palmer classification system. Dorsal tears were first discussed by Estrella et al in 2007 21 ; other authors have also reported the existence of dorsal TFCC tears.…”

“…Dorsal tears were first discussed by Estrella et al in 2007 21 ; other authors have also reported the existence of dorsal TFCC tears. 46,47 Abe et al stated that a dorsal tear can entrap the ulnar head and cause restricted rotation of the forearm 47 .…”