Management of Distal Radius Fracture-Associated TFCC Lesions Without DRUJ Instability

  • Alejandro BadiaEmail author


Fractures of the distal end of radius account for nearly 20% of all fractures seen in a routine emergency room and are commonly associated with intercarpal ligamentous injuries and other soft tissue disruptions [6]. The structure most frequently injured in distal radial fractures is the triangular fibrocartilage complex (TFCC) [15, 21, 24, 27]. In one cadaveric study where a hyperextension force was applied to cadaveric wrists until a distal radial fracture occurred, an injury to the TFCC occurred in 63% of the specimens followed by injuries to scapholunate ligament (32%) and to lunotriquetral ligament (17%) [20]. The TFCC consists of the central fibrocartilage, the dorsal and palmar distal radioulnar ligaments, the sheath of extensor carpi ulnaris tendon, the ulnar collateral ligaments, and the ulnocarpal ligaments. It works as a single unit that aids in movements, stability, and load sharing at the wrist. The central area of TFCC is avascular and called the debridement zone, whereas, the peripheral zone enjoys an extensive blood supply and is termed the repair zone [25] (Fig. 5.1).


Distal Radius Fracture Suture Repair Carpal Tunnel Release Ulnar Collateral Ligament Distal Radial Fracture 
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The author acknowledges Dr. Prakash Khanchandani assistance in reviewing the literature and writing this article.


  1. 1.
    Abboudi J, Culp RW. Treating fractures of the distal radius with arthroscopic assistance. Orthop Clin North Am. 2001;32:307–15CrossRefPubMedGoogle Scholar
  2. 2.
    Agee JM, McCarroll HR Jr, Tortosa RD, Berry DA, Szabo RM, Peimer CA. Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg Am. 1992;17A:987–95CrossRefGoogle Scholar
  3. 3.
    Auge ANX, Velasquez PA. The application of indirect reduction techniques in the distal radius: the role of adjuvant arthroscopy. Arthroscopy. 2000;16:830–5CrossRefPubMedGoogle Scholar
  4. 4.
    Badia A. Median nerve compression secondary to fractures of distal radius. In: Luchetti R, Amadeo P, editors. Carpal tunnel syndrome. Berlin: Springer; 2006Google Scholar
  5. 5.
    Badia A, Jimenez A. Arthroscopic repair of peripheral triangular fibrocartilage complex tears with suture welding: a technical report. J Hand Surg Am. 2006;31A:1303–7CrossRefGoogle Scholar
  6. 6.
    Badia A, Khanchandani P. Volar plate fixation. In: Slutsky DJ, Osterman AL, editors. Distal radial fractures and carpal injuries: the cutting edge. Philadelphia: Elsevier; 2008Google Scholar
  7. 7.
    Bouaziz H, Narchi P, Mercier FJ, Khoury A, Poirier T, Benhamou D. The use of a selective axillary nerve block for outpatient hand surgery. Anesth Analg. 1998;86(4):746–8CrossRefPubMedGoogle Scholar
  8. 8.
    Bohringer G, Schadel-Hopfner M, Junge A, Gotzen L. Primary arthroscopic treatment of TFCC tears in fractures of the distal radius [German]. Handchir Mikrochir Plast Chir. 2001;33(4):245–51CrossRefPubMedGoogle Scholar
  9. 9.
    Cheng HS, Hung LK, Ho PC, Wong J. An analysis of causes and treatment outcome of chronic wrist pain after distal radial fractures. Hand Surg. 2008;13(1):1–10CrossRefPubMedGoogle Scholar
  10. 10.
    Doi K, Hattori Y, Otsuka K, Abe Y, Yammamoto H. Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation. J Bone Joint Surg. 1999;81A:1093–110Google Scholar
  11. 11.
    Edwards CC, Harszti CJ, McGillivary GR, Gutow AP. Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction. J Hand Surg Am. 2001; 26A:1036–41CrossRefGoogle Scholar
  12. 12.
    Geissler WB, Freeland AE. Arthroscopically assisted reduction of intraarticular distal radius fractures. Clin Orthop Relat Res. 1996;327:125–34CrossRefPubMedGoogle Scholar
  13. 13.
    Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am. 1996;78A(3):357–65Google Scholar
  14. 14.
    Lindau T, Arner M, Hagberg L. Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg Am. 1997; 22B:638–43Google Scholar
  15. 15.
    Lindau T, Adlercreutz C, Aspenberg P. Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radius fractures. J Hand Surg Am. 2000;25A:464–8CrossRefGoogle Scholar
  16. 16.
    Mathoulin C, Sbihi A, Panciera P. Interest in wrist arthroscopy for treatment of articular fractures of the distal radius: report of 27 cases [French]. Chir Main. 2001;20(5): 342–50CrossRefPubMedGoogle Scholar
  17. 17.
    Orbay JL, Badia A, Indriago IR, et al. The extended flexor carpi radialis approach: a new perspective for the distal radius fracture. Tech Hand Up Extrem Surg. 2001;5(4):204–11CrossRefPubMedGoogle Scholar
  18. 18.
    Osterman AL, Vanduzer ST. Arthroscopy in the treatment of distal radial fractures with assessment and treatment of associated injuries. Atlas Hand Clin. 2006;11:231–41Google Scholar
  19. 19.
    Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am. 1989;14A:594–606CrossRefGoogle Scholar
  20. 20.
    Pechlaner S, Kathrein A, Gabl M, et al. Distal radius ­fractures and concomitant lesions. Experimental studies ­concerning the pathomechanism. Handchir Mikrochir Plast Chir; 2002; 34:150–7CrossRefGoogle Scholar
  21. 21.
    Richards RS, Bennett JD, Roth JH, et al. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am. 1997;22(5):772–6CrossRefPubMedGoogle Scholar
  22. 22.
    Rominger MB, Bernreuter WK, Kenney PJ, et al. MR imaging of anatomy and tears of wrist ligaments. Radiographics. 1993;13(6):1233–48PubMedGoogle Scholar
  23. 23.
    Ruch DS, Valle J, Poehling GG, et al. Arthroscopic reduction versus flouroscopic reduction in the management of intra-articular distal radius fractures. Arthroscopy. 2004;20: 225–30CrossRefPubMedGoogle Scholar
  24. 24.
    Shih JT, Lee HM, Hou YT, et al. Arthroscopically-assisted reduction of intra-articular fractures and soft tissue management of distal radius. Hand Surg. 2001;6(2):127–35CrossRefPubMedGoogle Scholar
  25. 25.
    Shih JT, Lee HM, Tan CM, et al. Early isolated triangular fibrocartilage tears: management by arthroscopic repair. J Trauma. 2002;53:922–7CrossRefPubMedGoogle Scholar
  26. 26.
    Stark RH. Neurologic injury from axillary block anesthesia. J Hand Surg Am. 1996;21(3):391–6CrossRefPubMedGoogle Scholar
  27. 27.
    Varitimidis SE, Basdekis GK, Dailiana ZH, Hantes ME, Bargiotas K, Malizos K. Treatment of intra-articular fractures of the distal radius: fluoroscopic or arthroscopic reduction. J Bone Joint Surg Br. 2008;90(6):778–85CrossRefPubMedGoogle Scholar
  28. 28.
    Weiss APC, Akelman E, Lainbiase R. Comparison of the findings of triple injection cinearthrography of the wrist with those of arthroscopy. J Bone Joint Surg. 1996;78A: 348–56Google Scholar
  29. 29.
    Wolfe SW, Easterling KJ, Yoo HH. Arthroscopic-assisted reduction of distal radius fractures. Arthroscopy. 1995;11(6): 706–14CrossRefPubMedGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Badia Hand to Shoulder Center, Baptist Hospital of MiamiDoralUSA

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