Dorsoradial Avulsion of the Triangular Fibrocartilage Complex with an Avulsion Fracture of the Sigmoid Notch of the Radius

Abstract

We report two extremely rare cases of dorsal radial avulsion injury of the triangular fibrocartilage complex accompanied by an avulsion fracture of the sigmoid notch of the radius. Anatomical reduction of the bone fragment in conjunction with reattachment of the dorsal portion of the radioulnar ligament to the radial sigmoid notch were necessary to restore stability of the distal radioulnar joint and tension of the triangular fibrocartilage proper.

Bucket-handle tear of the triangular fibrocartilage complex: case report of a complex peripheral injury with separation of the distal radioulnar ligaments from the articular disc

“…The ulnar attachment of the TFCC is composed of two distinct laminae which are separated by the ligamentum subcruentum: the proximal lamina is oriented vertically and inserts on the ulnar fovea, whereas the distal lamina runs horizontally and inserts on the ulnar styloid process [16]. To our knowledge, dorsal peripheral tears of the TFCC, with or without associated ulnocarpal ligaments injury, have rarely been reported in the literature so far [4][5][6]. Our case seems to be the first to demonstrate partial separation of both palmar and dorsal DRULs from the articular disc, forming a bucket-handle tear of the TFCC (in analogy with a superior labral anteroposterior (SLAP) 3 lesion, Figs.…”

“…Distal tears (class 1C) imply injury to the palmar ulnocarpal (ulnolunate and/or ulnotriquetral) ligaments. However, dorsal peripheral tears, with or without ulnocarpal ligaments injury, were not described in Palmer classification system and have rarely been reported in the literature since [4][5][6]. Those kind of peripheral tears are important to recognize, as they may lead to distal radioulnar joint (DRUJ) and/or wrist instability [7,8].…”

Dry Arthroscopy of the Wrist: Its Role in the Management of Articular Distal Radius Fractures

“…If untreated, it can be asource of secondary instability and pain (36). Usually the radio-ulnar ligament is avulsed with a fleck of bone and reinsertion of it restores both congruency at the sigmoid notch and stability.…”

“…Finally instability can be due to complete avulsion of the distal radio-ulnar ligaments and TFC from the radius (so-called class ID tear) (27). If untreated, it can be asource of secondary instability and pain (36). Usually the radio-ulnar ligament is avulsed with a fleck of bone and reinsertion of it restores both congruency at the sigmoid notch and stability.…”

Fragmento dorso-ulnar en fracturas de radio distal: clasificación y manejo

“…9 En los últimos años, se le ha dado importancia al manejo específico de cada fragmento para lograr una correcta reducción, donde la mayoría de los estudios se centran en la congruencia articular radio-carpiana, existiendo escasa literatura en relación al manejo de fragmentos que involucran la articulación radio-ulnar distal (RUD), aun cuando cerca del 70% de las fracturas comprometen esa articulación y las alteraciones a ese nivel pueden llevar a la disminución de la funcionalidad y dolor a largo plazo. [9][10][11][12][13][14][15] El fragmento dorso-ulnar (FDU) es un fragmento de relativa frecuencia en la fractura intra-articular del radio y ha sido descrito en la literatura otorgándole importancia a la hora de la reducción quirúrgica, sugiriéndose un manejo específico dirigido de ese fragmento. 16,17 Nosotros consideramos que es necesario evaluar las fracturas que involucran el segmento dorso-ulnar como una fractura bi-articular, ya que comprometen tanto la fosa semilunar y la fosa sigmoidea, con el objeto de realizar un manejo adecuado de ese fragmento y así lograr una reducción articular anatómica.…”