Results of 12 Open Triangular Fibrocartilage Repair associated with radius fracture

1. Results of 12 Open Triangular Fibrocartilage Repair associated with radius fracture Kevin Wong JH, Sreedharan S, Yong FC, Teoh LC, Chew WY Tan Tock Seng HospitalSingapore Hand & Microsurgery sectionDepartment of Orthopaedics

2. Introduction • TFCC tears associated with radius fractures are common and frequently missed • Untreated TFCC tears can lead to debilitating ulnar sided pain and destabilizing symptoms • TFCC can be addressed at the same time during the radius fixation • We present our results of acute TFCC open repair in association with a radius fixation

3. TFCC tears without ulnar styloid fracture • 10 cadaveric specimens DRUJ distracted to failure • No ulnar styloid fractures Adams BD, Samani JE, et al: Triangular fibrocartilage injury: a laboratory model.  J Hand Surg [Am]  1996; 21:189-193.

4. TFCC associated with distal radius fractures • 1995-1997 • 51 patients with displaced distal radius fractures had wrist arthroscopy done • 43 had complete/partial tears of TFCC • 13-15 years after the injury • 17/38 lax DRUJ Mrkonjic A, Geijer M, Lindau T, Tägil M. The natural course of traumatic triangular fibrocartilage complex tears in distal radial fractures: a 13-15 year follow-up of arthroscopically diagnosed but untreated injuries. J Hand Surg Am. 2012 Aug;37(8):1555-60. doi: 10.1016/j.jhsa.2012.05.032.

5. Methodology • Retrospective study • All open TFCC repair with radius fixation from July 2009-April 2012 • Data from clinical records and database • Data analysis with SPSS v19.0

6. Methodology Exclusion criteria • Delayed fixations requiring osteotomy • Secondary surgeries • Fixations requiring external fixation

7. Results • From July 2009-April 2012, 12 cases met the inclusion criteria. • 1 patient had concomitant facial fracture • 2 had ulnar head fractures • All 12 cases tears were class 1B tears (Palmar classification) without ulnar styloid fracture

8. Results - Epidemiology Age Mean: 49.6 Range: 27-73 25% 75%

9. Mechanism

10. Results: Injury patterns/time • 7 close fractures • 5 open fractures (Gustilo 1) • Time to surgery • Mean 1.3 days • Range (0 – 7 days) • Open fractures < 1 day

11. Pre-operative parameters • 4 had DRUJ widening on pre-operative xrays

12. Results: Surgical details 67%

13. Brian D. Adams. Green’s Operative Hand Surgery, 5th ed.

14. Post-operative: Rehabilitaion • External splint (Munster) or internal (k-wires) for 6 weeks • Interval mobilisation exercises except supination and pronation for 6 weeks

15. Follow up period • 1, 3, 6 weeks • 3, 6, 12, 24, 36 months • Mean follow up 14 months

16. Results: Clinical outcome • Mean grip strength 74.3% of uninjured side • 1 had laxity on examination

17. Complications • Ulnar sided pain – 3 (2 resolved after 6 months) • Instability symptoms – 1 (required reconstruction) • Ulnar nerve symptoms – 0 • Infection – 0

18. Summary • TFCC tears are commonly associated with radius fractures and are commonly missed especially in distal radius fractures • Acute repair in the same setting with fixation of the radius fracture will allow good stability