gms | German Medical Science

Introduction: Triangular fibrocartilage complex (TFCC) injury is a common cause of ulnar-sided wrist pain in pediatric patients and can be difficult to identify. In the pediatric population, patients often present with TFCC pathology secondary to acute trauma, physeal arrest, or chronic, repetitive damage. Although some patients respond to conservative therapy, TFCC repair (arthroscopic or open) can be definitive treatment for those with persistent pain and functional limitations.

Objective: To report the outcomes following surgical TFCC repair in pediatric patients.

Methods: Medical records of pediatric patients who underwent TFCC repair at an academic pediatric hospital between 2004-2018 were reviewed for demographics, operative reports, clinical/occupational therapy notes and imaging reports. Inclusion criteria included 1 month minimum follow-up and confirmed TFCC injury. Patient outcomes were analyzed according to Palmer classification, ROM, grip strength, and PODCI scores.

Results and Conclusions: 89 patients (40:49, 14.6 (9.5-28.7); M:F, age (range)) diagnosed with TFCC injury and underwent 88 arthroscopic and 7 open surgical operations. The mean follow-up time was 16.5 months (1-68 months). 38 children (43%) had distal radius and/or ulna fractures prior to diagnosis of TFCC injury. The most common cause of injury was sport (31). 82 patients (92%) had diagnostic MRI prior to surgery with 75 patients having positive pathologic imaging findings confirmed by arthroscopy, while 7 patients (8.5%) had false negative MRI findings with pathology later identified at time of arthroscopy. Palmer classification 1B (67%) and 1D (11%) were most commonly seen on arthroscopy. 32 patients (36%) were simultaneously treated for ulnar impaction/abutment and/or distal radial growth arrest at the time of TFCC repair. Following surgery, mean grip strength increased 21.2 kg on average (p<0.05). 74 patients (83%) recovered full ROM. Patients with available goniometric data, wrist flexion improved 13.92% (p<0.05). PODCI Upper Extremity function & pain scores increased 30 and 42 points following surgery, respectively (p<0.05).

MRI imaging was a useful diagnostic tool in identifying TFCC pathology (91.4% sensitivity). Palmer Classification 1B (67%) and 1D (11%) were the most common TFCC injuries encountered. Surgical TFCC treatment (arthroscopic and/or open) led to significant increases in PODCI function & pain scores, ROM, and grip strength.