Patterns of triangular fibrocartilage complex (TFCC) injury associated with severely dorsally displaced extra-articular distal radius fractures

Injury, 05/11/2012

Scheer JH et al. – Severe displacement of an extra–articular radius fracture suggests an ulnar–sided ligament injury to the triangular fibrocartilage (TFCC). The observed lesions concur with findings in a previous cadaver study. The lesions follow a distinct pattern affecting both radioulnar as well as ulnocarpal stabilisers.

Methods

  • Twenty adult patients with an Arbeitsgemeinschaft fur Osteosynthesefragen (AO), type A2 or A3, distal radius fracture with an initial dorsal angulation greater than 20° were included.
  • Nine had a tip fracture (distal to the base) of the ulnar styloid and 11 had no such fracture.
  • They were all openly explored from an ulnopalmar approach and TFCC injuries were documented.
  • Eleven patients also underwent arthroscopy and intra-articular pathology was recorded.

Results

  • All patients had TFCC lesions of varying severity, having an extensor carpi ulnaris subsheath avulsion in common.
  • Eighteen out of 20 also displayed deep foveal radioulnar ligament lesions, with decreasingly dorsal fibres remaining.
  • The extent of this foveal injury could not be appreciated by radiocarpal arthroscopy.

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