TFCC Surgery Procedures

The triangular fibro cartilage complex (TFCC) is a tiny section of cartilage and ligaments on the little finger side of the wrist. A slight injury of the TFCC may be a wrist sprain. The soft tissues of the wrist are complex, working together to steady the mobile wrist joint. Interruption of this area because of injury or deterioration may cause more than just a wrist sprain and can be a hindering wrist disorder.

TFCC

• When a wrist injury occurs, the cartilage or ligaments can be torn. Common symptoms of TFCC are pain in the side of the wrist and a clicking sound or a catching feeling when you move the wrist. Technicians perform X-rays, magnetic resonance imaging (MRI) and arthrograms to diagnose TFCC.

Parts of the Wrist

• Eight small carpal bones form two rows to make the wrist. The proximal row is located where the wrist folds when it bends, and the distal row meets the proximal row toward the fingers. The proximal row links the radius and ulna (the bones in the lower arm) to the bones of the hand. On the ulna side (little finger side) of the wrist, the end of the ulna bone moves with two carpal bones (lunate and triquetrum). The TFCC suspends the ends of the radius and ulna over the wrist. The TFCC enables the wrist to move in six different directions.

Arthroscopic TFCC Repair

• Arthroscopic debridement is a common surgical method used to repair TFCC. It typically works well for small tears. Surgeons remove most of the damaged tissue while keeping the wrist joint stable. They use repair sutures to reattach the torn ligaments or cartilage. They also repair some ligament ruptures with fracture arthroscopically by reattaching and placing in screws and wires to help hold the repaired ligament in place while healing occurs.

Open Repair of TFCC

• Some complex tears require open repair. Open repair means that a surgeon makes an incision to open the tissue in order to perform the operation. This provides a better view and access to the area for the surgeon. The ligaments or cartilage damaged and severity of the injury determine whether or not open surgery is required. When surgery is delayed so long that the torn ligament or cartilage has retracted so far that the surgeon cannot perform repair, a tendon graft can help strengthen the repair.

Ulna (Diaphyseal) Shortening Method and Distal Ulna Shortening Osteotomy (Feldon wafer method)

• Degenerative and persistent TFCC sometimes necessitates an uncommon surgical method. Arthroscopic debridement is not typically as successful with these conditions as it is with acute TFCC. In severe cases it may be essential to shorten the ulna bone to provide pain relief. Two surgical procedures can shorten the ulna bone and unload the ulnocarpal joint. They are the ulna (diaphyseal) shortening method and distal ulna head shortening osteotomy (Feldon wafer method). The amount of shortening needed determines which surgical procedure is performed. Diaphyseal shortening method has a higher complication rate than distal ulna head shortening osteotomy. The distal ulna head shortening osteotomy is less invasive. Surgeons perform it either arthroscopically or as an open surgery.