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TFCC Tear: Associated Injuries

- See: Ligaments of the Wrist

- Discussion:
        - lunotriquetral interosseous ligament tear - relatively frequent occurance;
        - scapholunate dissociation - less frequent occurance;
        - ulnocarpal impaction syndrome (which can also mimic TFCC tear);
                - impingement of distal ulna on the carpi;
                - patients may have increased ulnar variance;
        - RU joint instability:
        - distal radius frx:
                - injury to triangular fibrocartilage is an often unrecognized element of distal radius fractures;
                - according to the report by Richards, et al (1997), TFCC tears occurred in 53% of extra-articular distal radius fractures vs 35% of intra-articular fractures;
                - in the report by Lindau T, et al, the authors performed a prospective study to determine whether peripheral tears of the triangular fibrocartilage complex (TFCC) in patients younger than the osteoporotic age (males,<60 years; females, <50 years) were related to chronic distal radioulnar joint (DRUJ) instability;
                         - 51 patients (27 women) with displaced distal radial fractures were included in the study;
                         - arthroscopy at the time of fracture showed complete or partial TFCC tears in 43 patients (24 had only peripheral tears, 10 had only central perforations, and 9 had combined tears);
                         - 10 of the 11 patients with complete peripheral TFCC tears had DRUJ instability at the follow-up examination compared with 7 of the 32 patients with only partial or no peripheral tears;
                         - instability was not associated with any radiographic finding either at the time of fracture or at the follow-up examination.
                         - initial fracture or nonunion of the styloid was even slightly more common in stable patients.
        - ulnar styloid frx;
                  - in the report by Richards, et al (1997), no correlation between ulnar styloid frx and TFCC tears could be found;
                        - Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures 
                        - Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. 
        - diff dx:
                  - diff dx includes: ECU tendinitis, occult frx, DJD of the pisoform-triquetral joint, and RU joint instability