Purpose
Distal radius fractures were associated with a high incidence of triangular fibrocartilage complex (TFCC) tear. However not all patients were noted to have signs and symptoms of TFCC insufficiency. We evaluate the status of TFCC after the union of distal radius fractures with plate fixation and the outcome for those who were symptomatic and underwent a delayed TFCC repair.
Method
and materials
88 patients with an average age of 52 years old and elected for the removal of implants after distal radius fractures union were recruited. Concomitant wrist arthroscopy was performed to assess the status of TFCC. Repair of TFCC was attempted for patients with symptomatic distal radioulnar joint (DRUJ) instability.
Results
There were 17 extra-articular distal radius fractures. 48 patients had ulnar wrist pain and 55 were noted to have DRUJ instability on examinations. The findings of wrist arthroscopies revealed 16 patients with intact TFCC while 69 were noted to have TFCC tears. 5 patients had combined tears. 32 tears were repaired and 37 were not repaired, based on patients’ symptoms and whether the tear was deemed repairable. There was association between ulnar wrist pain and clinical DRUJ instability, p=0.05. There was association between ulnar wrist pain and ulnar styloid fracture, irrespective whether it is united, p=0043. Yet there was no correlation between ulnar wrist pain and TFCC tears. There was no correlation between ulnar styloid fractures and TFCC tears.
At up to 12 months post wrist arthroscopy, the average range of wrist movement, power and the qDASH score were noted to be significantly improved for all 3 groups i.e. patients with intact TFCC, patients with non-repaired TFCC and patients with repaired TFCC. Yet, no sustained statistically significant difference was observed in these parameters between groups.
Conclusion
A large majority of TFCC tears remained to be unhealed after the union of distal radius fracture. However, their clinical outcomes may not differ from those with intact TFCC. For those with symptomatic DRUJ instability, a delayed TFCC repair can improve their outcome.