What Happens to Untreated TFCC Wrist Injuries?
Wrist pain at rest and with activities along with loss of strength and decreased function are disabling problems associated with triangular fibrocartilage complex (TFCC) tears. The triangular fibrocartilage complex (TFCC) suspends the ends of the radius and ulna bones over the wrist. It is triangular in shape and made up of several ligaments and cartilage.
The TFCC makes it possible for the wrist to move in six different directions (bending, straightening, twisting, side-to-side). It stabilizes the distal radioulnar joint while improving the range of motion and gliding action within the wrist.
In this study, hand surgeons took a look at what happened to a group of patients with a displaced distal radial fracture that also caused a TFCC tear. The fracture was treated but the damaged soft tissue was not. These patients were treated for the fracture 10 to 15 years ago when the treatment protocol at that time did not call for TFCC repair or reconstruction.
The question they asked was, "What happens to untreated TFCC injuries?" We call this the natural history of a condition. Certainly, there is always a concern for arthritis developing after a traumatic injury. But does it? Are patients with untreated TFCC tears still unstable years later? To find out, they contacted a group of patients who met this criteria. Through telephone interviews, examinations, and X-rays, they were able to see some important trends.
First, there did not appear to be any direct link between wrist joint laxity present from the lack of the TFCC tension and subsequent arthritis. There were some patients who developed wrist arthritis but not any more than the general adult population who don't have wrist injuries. The group as a whole did have some weakness in grip strength but this was not disabling.
About half the group had joint laxity (looseness) but not instability (joint slippage). Only one patient was unstable enough to have surgery. The others seemed to manage and adapt without further problems. Patients who only had a partial tear did have better overall results compared with those who had a complete TFCC tear.
The authors concluded from this study there was not enough evidence to suggest aggressive surgical treatment of TFCC tears when this type of associated soft tissue injury occurs along with a distal radius (wrist) fracture. However, the number of patients in the study was small (38) so they do advise further (larger) studies need to be conducted in order to further confirm or clarify their own findings.
Ante Mrkonjic, MD, et al. 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. In The Journal of Hand Surgery. August 2012. Vol. 37A. No. 8. Pp. 1555-1560.