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The Natural Course of Traumatic Triangular Fibrocartilage Complex Tears in Distal Radial Fractures: A 13-15 Year Follow-up of Arthroscopically Diagnosed but Untreated Injuries.

Mrkonjic, Ante LU ; Geijer, Mats LU ; Lindau, Tommy and Tägil, Magnus LU (2012) In The Journal of hand surgery 37(8). p.1555-1560
Abstract
PURPOSE:

To evaluate the long-term results of a prospective, longitudinal case series of untreated, traumatic triangular fibrocartilage complex (TFCC) tears found in displaced distal radial fractures.



METHODS:

Between 1995 and 1997, 51 patients (24 men, 27 women; age, 20-57 y) with a displaced distal radius fracture had wrist arthroscopy to identify associated injuries. Forty-three patients had complete or partial tears of the TFCC, which were not treated. All patients were contacted in 2010, 13-15 years after the injury. One patient had had a TFCC reattachment due to painful distal radioulnar joint instability and was excluded. Thirty-eight patients returned for a radiographic and clinical follow-up... (More)
PURPOSE:

To evaluate the long-term results of a prospective, longitudinal case series of untreated, traumatic triangular fibrocartilage complex (TFCC) tears found in displaced distal radial fractures.



METHODS:

Between 1995 and 1997, 51 patients (24 men, 27 women; age, 20-57 y) with a displaced distal radius fracture had wrist arthroscopy to identify associated injuries. Forty-three patients had complete or partial tears of the TFCC, which were not treated. All patients were contacted in 2010, 13-15 years after the injury. One patient had had a TFCC reattachment due to painful distal radioulnar joint instability and was excluded. Thirty-eight patients returned for a radiographic and clinical follow-up that recorded strength, distal radioulnar joint laxity, range of motion, pain scale score, and subjective and objective outcome scores.



RESULTS:

After 13-15 years, 17/38 patients were lax in the distal radioulnar joint. The mean grip strength was worse in the patients with a lax distal radioulnar joint (83%, SD 15 of the contralateral side vs 103%, SD 33). The median Gartland and Werley score was 5 (good; range, 0-15) in the lax group compared to 1 (excellent; range, 0-9) in the non-lax group, and the median Disabilities of the Arm, Shoulder, and Hand scores were 14 (range, 0-59) and 5 (range, 0-70) respectively.



CONCLUSIONS:

In this 13-15 year, prospective, longitudinal outcome study of the natural course of TFCC tears associated with distal radius fracture, only 1 patient had been operated on for painful instability since the injury. The subjective and objective results did not provide evidence that a TFCC injury would influence the long-term outcome. However, trends were found and, by speculation, the low number of patients in the series and the risk for a type II error could be the cause of absent statistically significance. Larger, preferably prospective, randomized studies are needed to find out whether a more aggressive treatment is beneficial.



TYPE OF STUDY/LEVEL OF EVIDENCE:

Diagnostic I. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Journal of hand surgery
volume
37
issue
8
pages
1555 - 1560
publisher
Elsevier
external identifiers
  • WOS:000307260200005
  • PMID:22835585
  • Scopus:84864232751
ISSN
1531-6564
DOI
10.1016/j.jhsa.2012.05.032
language
English
LU publication?
yes
id
e7b2ff59-4aad-4dfb-9cc7-1059aabf7d4a (old id 2966533)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22835585?dopt=Abstract
date added to LUP
2012-08-10 08:42:43
date last changed
2017-01-08 05:35:18
@article{e7b2ff59-4aad-4dfb-9cc7-1059aabf7d4a,
  abstract     = {PURPOSE:<br/><br>
To evaluate the long-term results of a prospective, longitudinal case series of untreated, traumatic triangular fibrocartilage complex (TFCC) tears found in displaced distal radial fractures.<br/><br>
<br/><br>
METHODS:<br/><br>
Between 1995 and 1997, 51 patients (24 men, 27 women; age, 20-57 y) with a displaced distal radius fracture had wrist arthroscopy to identify associated injuries. Forty-three patients had complete or partial tears of the TFCC, which were not treated. All patients were contacted in 2010, 13-15 years after the injury. One patient had had a TFCC reattachment due to painful distal radioulnar joint instability and was excluded. Thirty-eight patients returned for a radiographic and clinical follow-up that recorded strength, distal radioulnar joint laxity, range of motion, pain scale score, and subjective and objective outcome scores.<br/><br>
<br/><br>
RESULTS:<br/><br>
After 13-15 years, 17/38 patients were lax in the distal radioulnar joint. The mean grip strength was worse in the patients with a lax distal radioulnar joint (83%, SD 15 of the contralateral side vs 103%, SD 33). The median Gartland and Werley score was 5 (good; range, 0-15) in the lax group compared to 1 (excellent; range, 0-9) in the non-lax group, and the median Disabilities of the Arm, Shoulder, and Hand scores were 14 (range, 0-59) and 5 (range, 0-70) respectively.<br/><br>
<br/><br>
CONCLUSIONS:<br/><br>
In this 13-15 year, prospective, longitudinal outcome study of the natural course of TFCC tears associated with distal radius fracture, only 1 patient had been operated on for painful instability since the injury. The subjective and objective results did not provide evidence that a TFCC injury would influence the long-term outcome. However, trends were found and, by speculation, the low number of patients in the series and the risk for a type II error could be the cause of absent statistically significance. Larger, preferably prospective, randomized studies are needed to find out whether a more aggressive treatment is beneficial.<br/><br>
<br/><br>
TYPE OF STUDY/LEVEL OF EVIDENCE:<br/><br>
Diagnostic I.},
  author       = {Mrkonjic, Ante and Geijer, Mats and Lindau, Tommy and Tägil, Magnus},
  issn         = {1531-6564},
  language     = {eng},
  number       = {8},
  pages        = {1555--1560},
  publisher    = {Elsevier},
  series       = {The Journal of hand surgery},
  title        = {The Natural Course of Traumatic Triangular Fibrocartilage Complex Tears in Distal Radial Fractures: A 13-15 Year Follow-up of Arthroscopically Diagnosed but Untreated Injuries.},
  url          = {http://dx.doi.org/10.1016/j.jhsa.2012.05.032},
  volume       = {37},
  year         = {2012},
}