gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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TFCC foveal tear with distal radius fracture

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  • presenting/speaker Hiroshi Ono - Hand Surgery Center, Nishinara Central Hospital, Nara, Japan
  • Daisuke Suzuki - Hand Surgery Center, Nishinara Central Hospital, Nara, Japan
  • Ryotaro Fujitani - Hand Surgery Center, Nishinara Central Hospital, Nara, Japan

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-673

doi: 10.3205/19ifssh0001, urn:nbn:de:0183-19ifssh00019

Published: February 6, 2020

© 2020 Ono et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Purpose: This study aims to evaluate the hypothesis that TFCC foveal tear is accompanied by distal radius fracture (DRF) with severely dislocated distal fragment of the radius. We also determined which specific radiological parameters were associated with TFCC foveal tear.

Methods: We retrospectively reviewed consecutive 137 patients with unstable DRFs treated by arthroscopic ORIF during a 3-year periods from July 2015. There were 111 female and 26 male, 64 right and 73 left hands, mean age 70 y.o. According to AO classification, type A were 24, B were 5, and C were 108 cases.

Radiographic parameters such as radial inclination (RI), ulnar variance (UV), volar tilt (VT) of preoperative standard PA and lateral radiographs were measured in all cases.

At operation, TFCC foveal insertion was observed arthroscopically by DRUJ approach or radiocarpal approach through teared TFCC disc proper if possible. The TFCC foveal insertion was divided into two groups (normal and tear). Tear group included both complete and partial tear of TFCC foveal insertion.

We compared the radiographic parameters between two groups by T test. We conducted the logistic regression analysis to investigate parameters associated with TFCC foveal tear by odds ratios (ORs) and 95% confidence intervals (Cls) for RI, UV, and VT and the ROC analysis to investigate the cutoff value.

Results: There were 40 cases in tear group and 97 in normal group. The mean RI, UV, VT of two groups (tear/normal) was 13.8/17.1, 4.1/2.4, -21.4/-8.9, respectively. All these parameters were statistically significant different between two groups (p= 0.015 (RI), 0.024 (UV), and 0.0009 (VT)). Logistic regression analysis demonstrated only the VT was significantly different (OR: 0.971, 95% Cl: 0.9510 to 0.992, p=0.0058). The ROC analysis showed the VT had the area under the curve at 69.1%. Using a cutoff of -13.2 degree, VT had 58% specificity and 75% sensitivity for TFCC foveal tear.

Conclusion: Our data demonstrated the distal radial fragment of DRF with TFCC foveal tear dislocated more severe than that with normal TFCC fovea. If the VT of preoperative radiograph is smaller than -13.2 degree, the TFCC foveal insertion should be observed directly or arthroscopically.