Article
Should we repair TFCC in distal radius fracture?
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Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Distal radius fractures are associated with a high incidence of trianglular fibrocartilage complex (TFCC) tears. Healing of TFCC tears is postulated after anatomical fixation. This study aims to evaluate the status of TFCC after the union of distal radius fractures and to assess its functional outcomes.
Methods: 80 patients who were elected for the removal of implants after union of distal radius fractures were recruited. Concomitant wrist arthroscopy was performed to assess the status of TFCC. Repair of TFCC was attempted for patients with symptomatic distal radioulnar joint (DRUJ) instability. The follow-up period was at least 1 year post wrist arthroscopy
Results and Conclusions: There were 18 extra-articular distal radius fractures out of 80 fractures. 45 patients had ulnar wrist pain and 54 were noted to have DRUJ instability on examinations. Their average DASH score was 39. The findings of wrist arthroscopies revealed 16 patients with intact TFCC. There were 64 complete tears and 26 incomplete tears showing signs of healing. Tears was significantly associated with DRUJ instability (p=0.02) on physical examination and the presence of ulnar styloid fracture but not with ulnar wrist pain (p=0.28). 32 tears were repaired and 32 were not repaired, based on patients' symptoms and whether the tear was deemed repairable.
When we evaluated the 3 subgroups, i.e. intact TFCC, unrepaired TFCC tear and repaired TFCC, we found that there was no statistically difference in their pain score, range of movement, power grip and their DASH score prior to the removal of implants. At 12 months post wrist arthroscopy, all groups had significant improvement in pain score, ROM, power and the DASH score, when compared with pre-arthroscopy. In addition, the group with intact TFCC had a significant higher grip strength than the 2 TFCC tear groups, irrespective whether they have been repaired or not (102 % vs 85% vs 86% p=0.015) at 12 months. There was no statistically difference in other parameters including pain, range of movement and DASH score.
A large majority of TFCC tears remained to be unhealed after fracture union. Yet their functional outcome may not differ from those with intact TFCC. Repair of all TFCC tears at the time of fracture may be overkill. A delayed repair for those with symptomatic instability appear to give satisfactory outcome.