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Patterns of triangular fibrocartilage complex (TFCC) injury associated with severely dorsally displaced extra-articular distal radius fractures
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
2012 (English)In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 43, no 6, 926-932 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of the study was to examine triangular fibrocartilage (TFCC) injury patterns associated with unstable, extra-articular dorsally displaced distal radius fractures.

Methods: Twenty adult patients with an Arbeitsgemeinschaft für Osteosynthesefragen (AO), type A2 or A3, distal radius fracture with an initial dorsal angulation greater than 20° were included. Nine had a tip fracture (distal to the base) of the ulnar styloid and 11 had no such fracture. They were all openly explored from an ulnopalmar approach and TFCC injuries were documented. Eleven patients also underwent arthroscopy and intra-articular pathology was recorded.

Results: All patients had TFCC lesions of varying severity, having an extensor carpi ulnaris subsheath avulsion in common. Eighteen out of 20 also displayed deep foveal radioulnar ligament lesions, with decreasingly dorsal fibres remaining. The extent of this foveal injury could not be appreciated by radiocarpal arthroscopy.

Conclusions: Severe displacement of an extra-articular radius fracture suggests an ulnar-sided ligament injury to the TFCC. The observed lesions concur with findings in a previous cadaver study. The lesions follow a distinct pattern affecting both radioulnar as well as ulnocarpal stabilisers.

Place, publisher, year, edition, pages
2012. Vol. 43, no 6, 926-932 p.
Keyword [en]
Distal radius fractures; Triangular fibrocartilage complex; Wrist injury; Pathomechanisms; Injury patterns
National Category
URN: urn:nbn:se:liu:diva-67921DOI: 10.1016/j.injury.2012.02.013ISI: 000304045100045OAI: diva2:414231

On the day of the defence date the title of this article was TFCC-injuries associated with severely displaced Colles’ fractures: a clinical study.

funding agencies|local County Council||

Available from: 2011-05-04 Created: 2011-05-02 Last updated: 2012-06-08Bibliographically approved
In thesis
1. Periulnar Injuries Associated with Distal Radius Fractures
Open this publication in new window or tab >>Periulnar Injuries Associated with Distal Radius Fractures
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Residual dysfunction after a fracture of the distal radius is most often mild but may give rise to significant impairment especially in the younger active population. The symptoms often manifest around the distal ulna when loading the hand or rotating the forearm. In this region are found articular and soft tissue connections running from the distal ulna to the distal radius as well as to the ulnar side of the carpus. The aims of this thesis were to investigate the effects of distal radius fractures on the structures about the distal ulna and to what extent malunion and ulnar soft tissue lesions affect function. Both patients and cadaver specimens were used in the five different studies.

In a retrospective study of 17 malunited distal radius fractures supination impairment improved significantly by correction of the skeletal malunion. This highlights the importance of distal radioulnar joint congruity for forearm rotation in a subset of cases.

The pathomechanisms of injury to the triangular fibrocartilage complex (TFCC) were studied. In a cadaveric distal radius fracture model different restraining properties and injury patterns were investigated. Similar patterns of injury were then observed in 20 patients with a displaced distal radius fracture. It was found that a TFCC injury can be expected with dorsal displacement of the distal radius fragment of 32o or more from the anatomically correct position. The distribution of a TFCC injury apparently differs depending on the size of an associated ulnar styloid fracture. In cases of an intact ulnar styloid or a concomitant tip fracture (Type 1) the first stage of injury seems to be extensor carpi ulnaris subsheath separation from the distal ulna and the dorsal radioulnar ligament. Thereafter follows a disruption of the deep insertions into the fovea of the ulna starting from the palmar and extending dorsally and radially. An extensive injury can be detected with a novel non-invasive test called the ‘bald ulnar head test’, which is performed under anaesthesia.

Diagnosis of an acute TFCC injury is difficult using non-invasive methods. In a prospective study of 48 patients, CT scanning to detect pathologic subluxation was found to be of little use in both acute and chronic cases, and is therefore not endorsed on this indication. A radioulnar stress test, which in previous studies has correlated well to a deep TFCC injury, was found to be highly reliable but not to correspond with significant disability in self-administered questionnaires of functional outcome two years or more after injury. This indicates that the subset of patients possibly benefiting from acute repair must be identified by other means.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 66 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1236
Triangular fibrocartilage complex, Distal radius fractures, Wrist injuries, Distal radioulnar joint, Ulnocarpal stability
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-67998 (URN)978-91-7393-201-1 (ISBN)
Public defence
2011-06-03, Berzeliussalen, Hälsouniversitete, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Available from: 2011-05-10 Created: 2011-05-04 Last updated: 2012-05-29Bibliographically approved

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Johan, ScheerLars, Adolfsson
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Orthopaedics and Sports MedicineFaculty of Health SciencesDepartment of Orthopaedics in Linköping
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