Traumatic disruption of the triangular fibrocartilage complex. Pathoanatomy

Abstract

The surgical pathology in 42 cases of traumatic triangular fibrocartilage complex (TFCC) disruption comprised a spectrum of injury resulting in five basic stages of increasingly severe ulnar wrist instability. In all cases, detachment of the articular disk from its ulnar insertion was the principal cause of distal radioulnar joint instability; in 28 (67%), concomitant injury to the adjacent extensor carpi ulnaris sheath, the ulnocarpal ligaments, or the peritriquetral ligaments compounded the instability. Thus, rather than an isolated event, peripheral disruption of the disk often proved the major constituent of multicomponent lesions--lesions consistently suitable for repair. In this series of destabilizing TFCC disruption requiring operative treatment, awareness that some injuries selectively affect the articular disk, whereas others compromise wider zones of wrist anatomy, was essential to successful surgery.