DIAGNOSIS AND TREATMENT OF TRIANGULAR FIBROCARTILAGE COMPLEX INJURY; A PRELIMINARY CLINICAL STUDY

ABSTRACT
Objectives: Triangular fibrocartilage complex (TFCC) injury
is one of the leading causes for localized persistant pain
at the ulnar side of the wrist. Preliminary treatment results of
the patients diagnosed with TFCC injury are assessed.
Patients and materials: 32 patients with TFCC injury
were treated in our department between 2007-2009. All patients
were evaluated with direct rontgenogram and MR imaging.
Mean time between the onset of symptoms and application
to the clinic was noted as 14 (4-42) months. Wrist
arthroscopy was performed for each patient. TFCC injury clasified
with Palmer clasification. Most of the lesions were type
1A lesions, noted at 19 of the patients. One patient had type
1B lesion, 3 patients had type 1C lesions, 4 patients had type
1D lesions and 5 patients had type 2C lesions. TFCC debridement
was used for each patient. One patient with peripheral
rupture was treated with suturing in an outside to inside fashion.
7 patients with distal radioulnar joint (DRUJ) instability
were treated with articular disc debridement and Fulkerson-
Watson extraarticular stabilization method. Two patients with
ulnar styloid fractures were treated with open reduction and
Kischner wire fixation following arthroscopic debridement.
Four patients with partial scapholunate ligament (SL) injury
were treated with debridement. Two patients with total SL
rupture were treated with arthroscopic TFCC debridement
followed by ligament reconstruction with modified Brunelli
suturing method three months later. Mean follow-up time
was noted as 11,6 months (6-21 months).
Results: Mean Quick-DASH-T (Disabilities of the Arm,
Shoulder and Hand-Turkish) symptom score was noted as
24,12 (range from 9,09 to 52,17) preoperatively and 6,99
(range from 2,27 to 25) postoperatively. Mean Visual Analog
Scoring (VAS) was notes as 7,24 (range from 4,5 to 9,2) and
2,12 (range from 0,3 to 5,4) at the preoperative and postoperative
period respectively.
Discussion: Injuries of the TFCC should be evaluated together
with the distal radioulnar joint (DRUJ), and the treatment
should be planned accordingly. Arthroscopic procedures
in the wrist yield successful results
Keywords: Triangular fibrocartilage complex, wrist,
treatment.