Triangular
fibrocartilage injuries
The
triangular fibrocartilage complex (TFCC) provides an articular surface
between the ulna and the ulnar carpal bones and provides stability to the
distal radioulnar joint while allowing pronation and supination. This structure
may be torn in a hyperextension/pronation mechanism, or associated with
a distal radius fracture. Palmer (Palmer) has classified traumatic TFCC
injuries as follows:
-
A Central
perforation
-
B Ulnar
avulsion with or without distal ulnar fracture
-
C Distal
avulsion
-
D Radial
avulsion with or without sigmoid notch fracture
Additionally,
acute injuries of the triangular fibrocartilage complex may be described
as nondestabilizing, destabilizing, or associated with fractures of the
distal radius and/or ulnar styloid. Nondestabilizing injuries, such as
a central perforation, are usually treated with several months of immobilization
before considering arthroscopic debridement. Destabilizing injuries, such
as disruption of the radial attachment with instability of the distal radioulnar
joint may be technically difficult to repair, requiring a combination of
arthroscopic and open techniques. Injuries associated with distal radius
fractures are underdiagnosed, and account for residual ulnar pain and distal
radioulnar instability following fracture. Hopefully, more aggressive arthroscopic
management of these lesions will reduce the incidence of long-term symptoms.
Triangular
Fibrocartilage Injuries