TY - JOUR
T1 - Foveal Triangular Fibrocartilage Complex Tears
T2 - Recognition of a Combined Tear Pattern
AU - Minhas, Shobhit
AU - Kakar, Sanjeev
AU - Wall, Lindley Bevelle
AU - Goldfarb, Charles Alan
N1 - Publisher Copyright:
© 2023
PY - 2023/10
Y1 - 2023/10
N2 - Purpose: Triangular fibrocartilage complex (TFCC) injuries are categorized most commonly by the Palmer and the Atzei and Luchetti classifications. Combined tears are reported less frequently, and the classification of these tears is unclear. In this study, we present a series of patients with combined central disc and foveal TFCC tears that do not fit into either of these classifications. Methods: Seventeen patients from 2 institutions presented with a combined central and foveal TFCC tear, confirmed by wrist arthroscopy between September 2017 and December 2020. Patient demographics, injury mechanism, associated injuries, clinical findings, magnetic resonance imaging results, surgeon description of tears, and treatment rendered were evaluated. Results: Patients were predominantly female (76%). Mean age was 40 years with a bimodal age distribution (7/17 patients <35 and 10/17 >45 years). Eleven patients (65%) sustained the injury from a fall. All had some degree of distal radioulnar joint (DRUJ) instability on clinical examination and almost half (8/17) had a history of a distal radius or ulnar styloid fracture during the initial injury. The foveal tear was confirmed by direct visual assessment and a positive hook test result; a suction test result commonly was positive as well. All patients underwent debridement of the central tear, and 16 of 17 underwent foveal TFCC repair with 1 having an irreparable tear. Conclusions: We present a series of patients with combined central disc and foveal TFCC tears, a pattern that does not fit current classification schemes. All patients exhibited some degree of instability of the DRUJ and almost half had a history of distal radius or ulnar styloid fracture. Identification of a central tear of the TFCC, together with even subtle DRUJ instability, should lead to consideration of a coexistent foveal tear. Type of study/level of evidence: Diagnostic IV.
AB - Purpose: Triangular fibrocartilage complex (TFCC) injuries are categorized most commonly by the Palmer and the Atzei and Luchetti classifications. Combined tears are reported less frequently, and the classification of these tears is unclear. In this study, we present a series of patients with combined central disc and foveal TFCC tears that do not fit into either of these classifications. Methods: Seventeen patients from 2 institutions presented with a combined central and foveal TFCC tear, confirmed by wrist arthroscopy between September 2017 and December 2020. Patient demographics, injury mechanism, associated injuries, clinical findings, magnetic resonance imaging results, surgeon description of tears, and treatment rendered were evaluated. Results: Patients were predominantly female (76%). Mean age was 40 years with a bimodal age distribution (7/17 patients <35 and 10/17 >45 years). Eleven patients (65%) sustained the injury from a fall. All had some degree of distal radioulnar joint (DRUJ) instability on clinical examination and almost half (8/17) had a history of a distal radius or ulnar styloid fracture during the initial injury. The foveal tear was confirmed by direct visual assessment and a positive hook test result; a suction test result commonly was positive as well. All patients underwent debridement of the central tear, and 16 of 17 underwent foveal TFCC repair with 1 having an irreparable tear. Conclusions: We present a series of patients with combined central disc and foveal TFCC tears, a pattern that does not fit current classification schemes. All patients exhibited some degree of instability of the DRUJ and almost half had a history of distal radius or ulnar styloid fracture. Identification of a central tear of the TFCC, together with even subtle DRUJ instability, should lead to consideration of a coexistent foveal tear. Type of study/level of evidence: Diagnostic IV.
KW - Central disc
KW - TFCC
KW - combined
KW - foveal tear
KW - wrist arthroscopy
UR - http://www.scopus.com/inward/record.url?scp=85132653126&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2022.03.010
DO - 10.1016/j.jhsa.2022.03.010
M3 - Article
C2 - 35550309
AN - SCOPUS:85132653126
SN - 0363-5023
VL - 48
SP - 1063.e1-1063.e6
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 10
ER -