[Trauma to the triangular fibrocartilaginous complex (TFCC)].

PURPOSE OF THE STUDY: The triangular fibrocartilaginous complex (TFCC) can be injured either due to trauma or by chronic strain. Based on these findings, Palmer devised a classification system distinguishing traumatic (I) and degenerative (II) TFCC lesions. Traumatic TFCC injury may be single or involved in a combined injury of the distal radius. The aim of this study was to evaluate the results of surgical treatment in patients with traumatic TFCC injury at six-month follow-up.

MATERIAL AND METHODS: In the years 2000 to 2004, 23 patients with injury to the wrist were treated. The group comprised 16 men and 7 women at an average age of 34 years (range, 17 to 54 years). Nine patients were diagnosed with a distal radial fracture and 14 had no damage to the bony structures. Of these, seven showed clinical signs of TFCC injury and were indicated to acute arthroscopy of the wrist. The remaining seven, due to persisting complaints, were examined by arthroscopy within 3 months of injury. During the arthroscopic procedure, the Palmer type of injury was identified and arthroscopic treatment, open or closed, was carried out at the same stage. All patients were followed up for 6 months for pain relief and return to full physical activity.

RESULTS: The arthroscopic examination revealed the following TFCC lesions: 11 central ruptures (I.A), 6 ulnar tears (I.B), 4 palmar (I.C) and 2 radial (I.D) avulsions. During arthroscopy, partial resection of the disc was performed in 13 cases (I.A, I.D), and reattachment of the disc to the styloid process of the ulna was carried out in six cases (I.B). In four of these patients the intervention was done at the stage of acute lesion within 4 weeks of injury, and in two within a longer period. Four patients with type I.C injuries underwent open disc reattachment from the palmar approach. Subjective evaluation showed that 65 % of the patients had no complaints, 26 % reported pain after excessive activity and 9 % had pain associated with daily activities. Nome of the patients reported rest pain.

DISCUSSION: In our group, 91 % of the patients reported excellent and very good results at six months of follow-up. The two patients experiencing pain in daily activities (9 %) had type I.B. injury and were indicated for arthroscopy at a time longer than 6 weeks after injury.

CONCLUSIONS: TFCC lesions are wrist injuries which, if diagnosed early and treated appropriately, show good healing. If the triangular fibrocartilage complex is damaged by a central tear, disc resection gives good results. However, if the distal radioulnar ligaments are torn, their reattachment is necessary in order to prevent instability of the distal radioulnar joint. Open surgical procedures interfere with integrity of the distal radioulnar joint ligaments, which may lead to joint instability and prolonged healing.