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Wrist and DRUJ Arthroscopy Findings of Triangular Fibrocartilage Complex in Distal Radius Fractures
Yukihiko Obara1; Toshiyasu Nakamura, MD, PhD2;Eiko Yamabe3
1Okubo Hospital, Tokyo, Japan; 2Keio University, Tokyo, Japan; 3Department of Orthopaedic Surgery, Keio University, Tokyo, Japan

Purpose: To evaluate the foveal detachment of the triangular fibrocartilage complex (TFCC) in distal radius fractures by wrist and distal radioulnar joint (DRUJ) arthroscopy.
Method: The participants included 182 patients who underwent surgery for distal radius fractures in 185 hands from 2007 to 2012. Male were 52 hands and female were 133 hands. The patients' average age was 61.0 years (range, 15-84 years), and the fracture occurred in the right hand in 73 patients and in the left hand in 112 patients. The research protocol was approved by the Human Subjects Committee at our hospital. All patients provided written informed consent to participate in this prospective study. Wrist and DRUJ arthroscopy were performed in all cases, and TFCC injuries, including perforation of the disc proper, radial edge injuries and ulnar fovea detachment, were identified. All statistical analyses were performed using the X2 test. Values of p<0.001 were considered statistically significant.
Results: The 57 patients with distal radius fractures without TFCC injury were young (average age: 48.7 years), while the 128 patients with distal radius fractures and TFCC injury were elderly (average age: 66.8 years). A TFCC injury was seen in 128 hands, involving the disc proper in 64 hands and the radial edge in 39 hands. DRUJ arthroscopy was performed in all patients, and TFCC fovea detachment was first seen on arthroscopy in 54 hands (average age: 69.7 years), but TFCC detachment was not seen in 131 hands (average age: 57.7 years). TFCC injury and detachment cases were older (p=1.57*10-13) than TFCC intact cases with distal radius fractures. TFCC ulnar detachment cases were older (p=4.04*10-6) than TFCC ulnar fovea intact cases with distal radius fractures.
Discussion: The present study confirmed that the incidence of TFCC injury in distal radius fractures is high (69.1%). Furthermore, DRUJ arthroscopy confirmed TFCC fovea detachment in 29.1% of hands. It was our impression that TFCC injury accompanies distal radial fracture. We believe that the results of the present study also included many existing age-related changes. In fact, when compared to the group without TFCC injury, the age of the group with TFCC injury was significantly higher.
Conclusion: The rate of foveal detachment of the triangular fibrocartilage in distal radius fractures was 29.1 %.


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