Open Repair for Avulsion Tear of the TFCC from the Fovea

ABSTRACT

In the year 2000, 16 wrists (9 right and 7 left) with traumatic avulsion of the triangular fibrocartilage complex (TFCC) from the ulnar fovea were treated with open repair. Average patient age was 28 years (range: 16-65 years). Follow-up was >1 year.

Posteroanterior radiographs indicated neutral ulnar variance in 11 wrists and positive ulnar variance in 5 wrists. Conservative treatment was applied for at least 3 months. Surgery was performed 4-22 months following the initial injury. Arthrogram or magnetic resonance imaging revealed TFCC avulsion from the fovea of the ulna in 16 wrists. All patients reported ulnar-sided wrist motion pain and severe distal radioulnar joint instability. Slack (severe translation of the ulna during pronosupination) was indicated in 13 wrists; however, no limit of pronosupination range was noted. Arthroscopy could not demonstrate TFCC avulsion from the ulnar fovea directly, but trampoline effect was noted in all wrists.

Double pull-out suturing of the ulnar ligamentous insertion of the TFCC was performed in the neutral variance wrist with 3-0 sutures, through two tunnels from the center of the fovea to the ulnar cortex of the ulna made by 1.2 mm Kirschner wire. In the positive variance wrist, an ulnar shortening procedure resolving the abutment was performed, followed by double pull-out suturing.

Postoperatively, an upper arm cast was applied for 2 weeks, followed by a lower arm cast for 3 weeks. At final follow-up, 15 wrists indicated no pain and slight pain remained in 1 wrist. Restabilization of the distal radioulnar joint was noted in 11 wrists; however slight distal radioulnar joint instability remained in 4 wrists. Severe distal radioulnar joint instability remained in 1 wrist. Eleven excellent, 4 good, and 1 fair result were obtained. Open repair of the TFCC was useful for treatment of the foveal avulsion.