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Abstract
Purpose:
To investigate short term clinical outcomes of the open surgical repair for triangular fibrocartilage complex (TFCC) foveal detachment.
Methods:
We retrospectively reviewed 8 patients (5 men, 3 women) who had been treated with open surgical repair of the TFCC type 1B injury, from 2005 to 2013 and who were followed up for more than one year after surgery. Mean age at time of surgery was 34 years. The right side was involved in 3 patients, and the left in 5. The clinical results of surgery were assessed with modified Mayo wrist score (MMWS), disabilities of the arm, shoulder and hand (DASH) score and pain-visual analogue scale (VAS). Physical examination was performed to evaluate the prescence of distal radioulnar instability, preoperatively and at the latest follow-up.
Results:
The mean follow up period were 36.5 months (range, 12-64 months). The mean MMWS improved from 52.5 (range, 25-85) preoperatively to 82.5 (range, 75–100) postoperatively (p=0.02). The mean DASH score improved from 39.6 (range, 65-13.5) preoperatively to 13.4 (range, 2.5-33.3) postoperatively (p=0.012). The preoperative mean pain-VAS was 4.6 (range, 6-3); these value was reduced to mean 2 (range, 0-3) at the latest follow-up (p=0.016). There were no patients remaining instability after the surgery, although four patients showed distal radioulnar joint (DRUJ) instability before surgery.
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Fig. 1.
(A-J) Photographs showing the operative procedure of open repair for triangular fibrocartilage complex using dorsal approach.
Fig. 2.
Case of patient presenting with persisted ulnar side wrist pain after the initial injury 5 years ago. (A) 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 scan. (B) Slight restriction of the pronation was observed. (C) 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. (D) Open repair of the deep fiber of TFCC to the original ulnar fovea (black arrow) was done using the transosseous suture technique. (E) Five years after the surgery, 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.
Table 1.
Patients details
Table 2.
Clinical Outcomes of the open surgical repair for triangularfibrocartilage complex foveal detachment (type 1B injury)
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