jkssh Journal of the Korean Society for Surgery of the Hand J Korean Soc Surg Hand 1598-3889 2234-0998 The Korean Society for Surgery of the Hand 10.12790/jkssh.2014.19.2.87 jkssh-19-87 REVIEW ARTICLE Open Repair of Triangular Fibrocartilage Complex Type 1B Tear RhyouIn Hyeok Upper Extremity and Microsurgery Center, Department of Orthopedic Surgery, Semyeong Christianty Hospital, Pohang, Korea Correspondence to: In Hyeok Rhyou, Department of Orthopedic Surgery, Pohang Semyeong Christianty Hospital, 351 Posco-daero, Nam-gu, Pohang 790-822, Korea, TEL: +82-54-289-1765, FAX: +82-54-289-1766, E-mail: osdrrih@gmail.com 06 2014 11 06 2014 19 2 87 94 15052014 05062014 Copyright © 2014 The Korean Society for Surgery of the Hand 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Most common traumatic type 1B tear of triangular fibrocartilage complex (TFCC), according to the Palmer's classification, may lead to the loss of the stability of distal radioulnar joint and is known to be one cause of the persisted ular side wrist pain. Recently as the knowledge of the anatomical structures of the TFCC accumulates and the deep fiber of the distal radioulnar ligament is recognized to play a central role, an attempt to repair it to the original ulnar fovea insertion site has been done and reported successful results. Since the introduction of open technique, numerous arthroscopic technique has been developing. Here careful considerations ought to be given during open repair will be taken with review of the related articles.

 Open repair Type 1B tear Triangular fibrocartilage complex References StuartPRBergerRALinscheidRLAnKNThe dorsopalmar stability of the distal radioulnar jointJ Hand Surg Am20002568999 GoftonWTGordonKDDunningCEJohnsonJAKingGJSoft-tissue stabilizers of the distal radioulnar joint: an in vitro kinematic studyJ Hand Surg Am20042942331 PalmerAKTriangular fibrocartilage disorders: injury patterns and treatmentArthroscopy1990612532 HagertEHagertCGUnderstanding stability of the distal radioulnar joint through an understanding of its anatomyHand Clin20102645966 EstrellaEPHungLKHoPCTseWLArthroscopic repair of triangular fibrocartilage complex tearsArthroscopy2007237293737 e1. HermansdorferJDKleinmanWBManagement of chronic peripheral tears of the triangular fibrocartilage complexJ Hand Surg Am1991163406 CooneyWPLinscheidRLDobynsJHTriangular fibrocartilage tearsJ Hand Surg Am19941914354 NakamuraTSatoKOkazakiMToyamaYIkegamiHRepair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniquesHand Clin20112728190 Garcia-EliasMSmithDELlusaMSurgical approach to the triangular fibrocartilage complexTech Hand Up Extrem Surg2003713440 PederziniLATosiMPrandiniMBotticellaCAll-inside suture technique for Palmer class 1B triangular fibrocartilage repairArthroscopy2007231130.e14 AtzeiANew trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instabilityJ Hand Surg Eur Vol20093458291 BainGIMcGuireDLeeYCEngKZumsteinMAnatomic foveal reconstruction of the triangular fibrocartilage complex with a tendon graftTech Hand Up Extrem Surg201418927 AdamsBDDivelbissBJReconstruction of the post-traumatic unstable distal radioulnar jointOrthop Clin North Am20013235363 MoritomoHAdvantages of open repair of a foveal tear of the triangular fibrocartilage complex via a palmar surgical approachTech Hand Up Extrem Surg20091317681 MoritomoHMasatomiTMuraseTMiyakeJOkadaKYoshikawaHOpen repair of foveal avulsion of the triangular fibrocartilage complex and comparison by types of injury mechanismJ Hand Surg Am201035195563 AndersonMLLarsonANMoranSLCooneyWPAmramiKKBergerRAClinical comparison of arthroscopic versus open repair of triangular fibrocartilage complex tearsJ Hand Surg Am20083367582 Figures

(A-J) Pictures showing the operative procedure of the dorsal approach of open repair.

Case of patient presenting with persisted ulnar side wrist pain after the initial injury 5 years ago. (A) Dorsal subluxation of the ulnar head (black arrow) on the lateral view of simple radiographs was found. (B) The detachment of deep fiber of triangular fibrocartilage complex (TFCC) from the ulnar fovea (pink arrow) was observed in coronal view of magnetic resonance imaging scans. (C) Slight restriction of the pronation was seen. (D) During the arthroscopic examination, synovitis around the prestyloid recess was found with the loss of the tension of the TFCC (positive trampoline test) and traction induced inward folding of the TFCC from the ulnar fovea (positive Hook test). Other combined injuries did not accompany. TFC, triangular fibrocartilage; C, capitate; H, hamate; L, lunate; T, triquetrum. (E) Open repair of the deep fiber of TFCC to the original ulnar fovea (black arrow) was done using the transosseous suture technique. (F) The reduced state of the preoperatively subluxated ulnar (pink arrow) head was seen on the follow-up radiographs taken at five years after operation. (G) Functional outcomes measured by Mayo modified wrist score and disability of the arm, shoulder and arm score improved from 55 preoperatively to 100 postoperatively and 35 to 3.3, separately.

Case of patient presenting with persisted ulnar side wrist pain after the initial injury 6 months ago despite of the initial conservative management using long arm cast for 4 weeks. (A) Except the finding of the interpositional arthroplasty of fourth and fourth carpometacarpal joint of the right side (pink arrow), specific finding was not found around the ulnar head (pink circle). The detachment of deep fiber of triangular fibrocartilage complex (TFCC) from the ulnar fovea (pink arrow) was observed in coronal view of magnetic resonance imaging scans (B) and computed tomography arthrogam (black arrow) (C). (D) Slight restriction of the volar and dorsiflexion was seen preoperatively. (E) During the arthroscopic examination (black arrow), synovitis (black arrow) around the prestyloid recess was found with the loss of the tension of the TFCC (positive trampoline test) and traction induced inward folding of the TFCC from the ulnar fovea (positive Hook test). Other injuries of the capitohamate instability and lunotriquetral instability accompanied. TFC, triangular fibrocartilage; C, capitate; H, hamate; L, lunate; T, triquetrum. (F) Open repair of the deep fiber of TFCC to the original ulnar fovea was done using the transosseous suture technique. (G) On the intraoperative fluoroscopic examination, well-positioned screws at the lunotriqetral and capitohamate joints was observed with the temoporary fixation of the distal radioulnar joint using two 2.0 mm K-wires. (H) Solid union of the lunotriquetral and capitohamate joints was seen on the simple radiographs taken at seven months after operation. (G) Functional outcomes measured by Mayo modified wrist score and disability of the arm, shoulder and hand score improved from 55 preoperatively to 99 postoperatively and 28.3 to 15, separately. (I) Near full range of motion except the slight limitation of the volar flexion was recovered.