Effect of untreated triangular fibrocartilage complex (TFCC) tears on the clinical outcome of conservatively treated distal radius fractures

  • Gokmen Deniz
  • Ozkan Kose
  • Serhat Yanik
  • Tugrul Colakoglu
  • Ali Tugay
Original Article

Abstract

Objective

The purpose of this study was to investigate the effect of untreated triangular fibrocartilage complex (TFCC) tear on the clinical outcome of conservatively treated distal radius fractures.

Materials and methods

This prospective study comprised 47 consecutive patients who presented at our clinic between January 2009 and January 2010 with displaced radius distal fracture and were treated with closed reduction and casting. During the first 15 days of treatment, all patients underwent wrist MR imaging to detect traumatic TFCC tears. At the final follow-up, all patients were evaluated with Mayo wrist function score and wrist radiographs. Patients were divided into two groups according to presence of TFCC tear, and two groups were analyzed statistically.

Results

The mean follow-up period was 38.9 ± 3.5 months (range 36–48). TFCC tear was detected in 24 cases, and remaining 23 cases had no TFCC tear. Both groups were statistically similar regarding age (p = 0.574), gender (p = 0.108), dominant side involvement (p = 0.339), fracture type (p = 0.709) and immobilization period (p = 0.514). According to Mayo wrist score, excellent results were obtained in 21 (44.7 %) cases, good in 16 (34.0 %) and satisfactory in 10 (21.3 %). No significant difference was observed between groups in wrist function scores (p = 0.451). Radiographic measurements were similar between groups (radial length p = 0.835, volar til p = 0.464, radial inclination p = 0.795).

Conclusions

Traumatic TFCC tears which are frequently seen together with distal radius fractures do not affect the long-term functional results. Therefore, further diagnostic tests and treatment of TFCC tears in patients with stable distal radius fractures may be unnecessary. However, it should be borne in mind as a reason for continuing wrist pain and instability after distal radius fractures despite proper radiologic recovery.

Keywords

Radius distal fractures Triangular fibrocartilage complex Conservative treatment 

References

  1. 1.
    Whitle AP (2003) Malunited fractures. In: Canale ST (ed) Campell’s operative orthopaedics international edition, 10th edn. Mosby, Pennsylvania, pp 3071–3124Google Scholar
  2. 2.
    Fernandez DL, Wolfe SW (2005) Distal radius fractures. In: Green PD (ed) Green’s operative hand surgery, 5th edn. Elsevier, Pennsylvania, pp 645–710Google Scholar
  3. 3.
    Simic PM, Weiland AJ (2003) Fractures of the distal aspect of the radius: changes in treatment over the past two decades. Instr Course Lect 52:185–195PubMedGoogle Scholar
  4. 4.
    McQueen M, Caspers J (1988) Colles fracture: does the anatomical result affect the final function? J Bone Joint Surg Br 70(4):649–651PubMedGoogle Scholar
  5. 5.
    Tan V, Katolik LI (2011) Hand and wrist travma. In: Flynn JM (ed) Orthopaedic knowledge update, 10th edn. AAOS, Rosemont, pp 351–362Google Scholar
  6. 6.
    Obert L, Rey PB, Uhring J, Gasse N, Rochet S, Lepage G, Serre A, Garbuio P (2013) Fixation of distal radius fractures in adults: a review. Orthop Traumatol Surg Res 99(2):216–234PubMedCrossRefGoogle Scholar
  7. 7.
    Cheng HS, Hung LK, Ho PC, Wong J (2008) An analysis of causes and treatment outcome of chronic wrist pain after distal radial fractures. Hand Surg 13(1):1–10PubMedCrossRefGoogle Scholar
  8. 8.
    Sarmiento A, Pratt GW, Berry NC, Sinclair WF (1975) Colles’ fractures: functional bracing in supination. J Bone Joint Surg Am 57(3):311–317PubMedGoogle Scholar
  9. 9.
    Fujitani R, Omokawa S, Akahane M, Iida A, Ono H, Tanaka Y (2011) Predictors of distal radioulnar joint instability in distal radius fractures. J Hand Surg Am 36(12):1919–1925PubMedCrossRefGoogle Scholar
  10. 10.
    Bombaci H, Polat A, Deniz G, Akinci O (2008) The value of plain X-rays in predicting TFCC injury after distal radial fractures. J Hand Surg Eur 33(3):322–326CrossRefGoogle Scholar
  11. 11.
    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(3):464–468PubMedCrossRefGoogle Scholar
  12. 12.
    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(8):1555–1560PubMedCrossRefGoogle Scholar
  13. 13.
    Palmer AK, Werner FW (1981) The triangular fibrocartilage complex of the wrist–anatomy and function. J Hand Surg Am 6(2):153–162PubMedCrossRefGoogle Scholar
  14. 14.
    Herrera M, Chapman CB, Roh M, Strauch RJ, Rosenwasser MP (1999) Treatment of unstable distal radius fractures with cancellous allograft and external fixation. J Hand Surg Am 24(6):1269–1278PubMedCrossRefGoogle Scholar
  15. 15.
    Cole DW, Elsaidi GA, Kuzma KR, Kuzma GR, Smith BP, Ruch DS (2006) Distal radioulnar joint instability in distal radius fractures: the role of sigmoid notch and triangular fibrocartilage complex revisited. Injury 37(3):252–258PubMedCrossRefGoogle Scholar
  16. 16.
    Haugstvedt JR, Berger RA, Nakamura T, Neale P, Berglund L, An KN (2006) Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg Am 31(3):445–451PubMedCrossRefGoogle Scholar
  17. 17.
    Khanchandani P, Badia A (2013) Functional outcome of arthroscopic assisted fixation of distal radius fractures. Indian J Orthop 47(3):288–294PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Ogawa T, Tanaka T, Yanai T, Kumagai H, Ochiai N (2013) Analysis of soft tissue injuries associated with distal radius fractures. BMC Sports Sci Med Rehabil 5(1):19 Epub ahead of printPubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    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(5):511–516PubMedCrossRefGoogle Scholar
  20. 20.
    Iordache SD, Rowan R, Garwin GJ, Osman S, Grewal R, Faber KJ (2012) Prevalence of triangular fibrocartilage complex abnormalities on MRI scans of asymptomatic wrists. J Hand Surg Am 37(1):98–103PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • Gokmen Deniz
    • 1
  • Ozkan Kose
    • 2
  • Serhat Yanik
    • 3
  • Tugrul Colakoglu
    • 4
  • Ali Tugay
    • 5
  1. 1.Batman Medical Park Hospital, Orthopaedics and Traumatology ClinicBatmanTurkey
  2. 2.Department of Orthoapedics and TraumatologyAntalya Education and Research HospitalAntalyaTurkey
  3. 3.Department of Orthopaedics and TraumatologyHaydarpasa Numune Education and Research HospitalIstanbulTurkey
  4. 4.Private Akay Hospital, Orthoapedics and Traumatology ClinicAnkaraTurkey
  5. 5.Batman Medical Park Hospital, Radiology ClinicBatmanTurkey

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