International Orthopaedics

, Volume 42, Issue 8, pp 1917–1922 | Cite as

The status of triangular fibrocartilage complex after the union of distal radius fractures with internal plate fixation

  • Margaret Woon Man FokEmail author
  • Christian Xinshuo Fang
  • Tak Wing Lau
  • Yin Keung Eric Fung
  • Boris Kwok Keung Fung
  • Frankie Ka Li Leung
Original Paper



Distal radius fractures are associated with a high incidence of triangular fibrocartilage complex (TFCC) tears. This study aims to evaluate the status of TFCC after the healing of distal radius fractures, and its clinical significance.


Wrist arthroscopies were performed on 43 distal radius fractures, with an average age of 54 years old.


Twenty-six complete tears and 15 partial healed tears were noted. Five out of eight patients with intact TFCC tears had neither signs nor symptoms, while eight patients with TFCC tears had no complaint. While no association was found between ulnar wrist pain and TFCC tears, there was association between DRUJ instability and TFCC tears and fovea tears. The function outcome did not differ with respect to the integrity of TFCC.


A large majority of TFCC tears remained unhealed after the union of distal radius fractures. However, not all patients with tear were symptomatic.


Distal radius fractures Triangular fibrocartilage complex Distal radial ulnar instability Surgery Wrist pain Wrist arthroscopy 


Financial support

This study does not receive any financial support from any company/government body.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval details

This study has received approval from the University of Hong Kong/Hospital Authority Western Cluster Institutional Review Board.

All the case illustration, images and figures given do not contain any identifiable patient information.


  1. 1.
    Geissler WB, Freeland AE, Sovoie FH, McIntyre LW, Whillpe TL (1996) Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 78:357–365CrossRefPubMedGoogle Scholar
  2. 2.
    Lindau T, Arner M, Hagberg L (1997) Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg Br 22: 638–643Google Scholar
  3. 3.
    Richards RS, Bennett JD, Roth JH, Milne K (1997) Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am 22:772–776CrossRefPubMedGoogle Scholar
  4. 4.
    Lindau T, Adlercreutz C, Aspenberg P (2000) Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg Am 25: 464–468Google Scholar
  5. 5.
    Mehta JA, Bain GI, Heptinstall RJ (2000) Anatomical reduction of intra-articular fractures of the distal radius. An arthroscopically-assisted approach. J Bone Joint Surg Br 82:79–86CrossRefPubMedGoogle Scholar
  6. 6.
    Ruch DS, Yang CC, Smith BP (2003) Results of acute arthroscopically repaired triangular fibrocartilage complex injuries associated with intra-articular distal radius fractures. Arthroscopy 19:511–516CrossRefPubMedGoogle Scholar
  7. 7.
    Mrkonjic A, Geijer M, Lindau T, Tägil M (2012) 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 37:1555–1560CrossRefPubMedGoogle Scholar
  8. 8.
    Orbay JL, Fernandez DL (2002) Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 27:205–215CrossRefPubMedGoogle Scholar
  9. 9.
    Medoff RJ (2006) Fragment specific fixation of distal radius fractures. Atlas. Hand Clin 11:163–174Google Scholar
  10. 10.
    Musgrave DS, Idler RS (2005) Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg Am 30:743–749CrossRefPubMedGoogle Scholar
  11. 11.
    Fok MWM, Klausmeyer MA, Fernandez DL, Orbay JL, Bergada AL (2013) Volar plate fixation of intra-articular distal radius fractures: a retrospective study. J Wrist Surg 2:247–254CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    von Elm E, Altman DG, Egger M et al (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349CrossRefGoogle Scholar
  13. 13.
    Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 14:594–606CrossRefPubMedGoogle Scholar
  14. 14.
    Muller MS, Koch P, Schazker J (1990) The comprehensive classification of fractures of long bones. Springer-Verlag, BerlinCrossRefGoogle Scholar
  15. 15.
    Lester B, Halbrecht J, Levy IM, Gaudinez R (1995) “Press test” for office diagnosis of triangular fibrocartilage complex tears of the wrist. Ann Plast Surg 35:41–45CrossRefPubMedGoogle Scholar
  16. 16.
    Schoneveld K, Wittink H, Takken T (2009) Clinimetric evaluation of measurement tools used in hand therapy to assess activity and participation. J Hand Ther 22:221–235CrossRefPubMedGoogle Scholar
  17. 17.
    Luchetti R, Atzei A, Cozzolino R, Fairplay T, Badur N (2014) Comparison between open and arthroscopic-assisted foveal triangular fibrocartilage complex repair for post-traumatic distal radio-ulnar joint instability. J Hand Surg Eur 39:845–855CrossRefGoogle Scholar
  18. 18.
    Thiru RG, Ferlic DC, Clayton ML, McClure DC (1986) Arterial anatomy of the triangular fibrocartilage of the wrist and its surgical significance. J Hand Surg Am 11:258–263CrossRefPubMedGoogle Scholar
  19. 19.
    Hermansdorfer JD, Kleinman WB (1991) Management of chronic peripheral tears of the triangular fibrocartilage complex. J Hand Surg Am 16:340–346CrossRefPubMedGoogle Scholar
  20. 20.
    Zimmerman RM, Jupiter JB (2014) Instability of the distal radioulnar joint. J Hand Surg Eur 39:727–738CrossRefGoogle Scholar
  21. 21.
    Culp RW, Osterman AL (1995) Arthroscopic reduction and internal fixation of distal radius fractures. Orthop Clin North Am 26:739–748PubMedGoogle Scholar
  22. 22.
    del Piñal F, Luchetti R, Mathoulin C (2010) Arthroscopic management of distal radius fractures. Springer-Verlag, BerlinCrossRefGoogle Scholar
  23. 23.
    Doi K, Hattori Y, Otsuka K, Abe Y, Yamamoto H (1999) Ntra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation. J Bone Joint Surg Am 81:1093–1110CrossRefPubMedGoogle Scholar
  24. 24.
    Zenke Y, Sakai A, Oshige T, Moritani S, Nakamura T (2009) The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius. Bone Joint J 91:102–107CrossRefGoogle Scholar
  25. 25.
    Buijze GA, Ring D (2010) Clinical impact of united versus nonunited fractures of the proximal half of the ulnar styloid following volar plate fixation of the distal radius. J Hand Surg Am 35:223–227CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedics and Traumatology, Queen Mary HospitalThe University of Hong KongHong KongHong Kong
  2. 2.Occupational Therapy DepartmentDavid Trench Rehabilitation CentreHong KongHong Kong

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