Management of Type 1A TFCC Tears
Triangular fibrocartilage complex (TFCC) injuries are a common cause of ulnar-sided wrist pain occurring after compression or shear injuries to the wrist, such as a fall onto outstretched hands. Clinical exam should focus on distinguishing pain from the TFCC versus other causes of ulnar-sided pain, and on stability of the distal radioulnar joint (DRUJ). In addition to plain radiographs, magnetic resonance imaging with or without arthography is also valuable in the diagnostic process. TFCC injuries are divided using into acute (Type I) and chronic (Type II) mechanisms, and further subdivided by the location and extent of injury. This chapter focuses on management of Type 1A tears, which occur in the central avascular region of the fibrocartilage and are not associated with DRUJ instability. For patients failing nonoperative treatment, arthroscopic evaluation and debridement of unstable flap tears to a stable rim is indicated. If positive ulnar variance is present, an ulnar-shortening procedure should also be performed. Results of debridement demonstrate excellent pain relief, high patient satisfaction, and a low complication rate. This chapter includes video.
