Pathomechanism of Triangular Fibrocartilage Complex Injuries in Patients with Distal-Radius Fractures: A Magnetic-Resonance Imaging Study

Abstract

Injury to the triangular fibrocartilage complex (TFCC) is one of the most common complications following a fracture of the distal radius. In this study, an examination of TFCC injuries in patients with distal-radius fractures was conducted using magnetic-resonance imaging (MRI); the aim of the study was to analyze the prevalence of TFCC injury as well as to suggest acceptable radiologic parameters for use in prediction of the injury pattern. Fifty-eight patients with distal-radius fractures who underwent MRI prior to undergoing open-reduction surgery between April 2020 and July 2021 were included in this study. An analysis of various radiologic parameters, the fracture type, and the MRI classification of TFCC injuries was performed. Radiologic parameters were used in the evaluation of distal radioulnar joint (DRUJ), radial shortening, and the dorsal angularity of the fracture. All of the patients in this study had definite traumatic TFCC injuries. A statistical relationship was observed between the radial length gap between the intact wrist and the injured wrist, which represents relative radial shortening, and the pattern of TFCC injury. In conclusion, the shortening of the distal radius, causing peripheral soft tissue of the ulnar side to become tauter, is highly relevant with regard to the pattern of TFCC injury. However, because no data on the clinical outcome were utilized in this study, it is lacking in clinical perspective. The conduct of further studies on patients' clinical outcome will be necessary.

Keywords: distal-radius fracture; magnetic-resonance-imaging study; open reduction; radial length; triangular fibrocartilage complex injury.

Figure 1

Patient’s flow chart. Patient profiles and the groups included in the study. MRI, magnetic-resonance imaging.

Figure 2

Radiologic parameter measurement technique. (A) Radial length. (B) Radial inclination. (C) DRUJ distance. (D) Fracture site width. (E) Dorsal angulation. (F) Sagittal translation. (G) Anteroposterior width. Radial translation ratio = C/D, Sagittal translation ratio = F/G. DRUJ, distal radioulnar joint.

Figure 3

Type 1D injury case. Sixty-three year-old female patient injured with her wrist flexed had AO/OTA type A2 fracture with 15′ volar angulation, showing 5 mm increased radial length gap (A), and had type 1D TFCC injury with relatively preserved peripheral and distal portion of TFCC (B). AO: arbeitsgemeinschaft fur osteosynthesfragen; OTA: orthopedic trauma association; and TFCC: triangular fibrocartilage complex.