J Korean Fract Soc.  2009 Jul;22(3):179-184. 10.12671/jkfs.2009.22.3.179.

TFCC Injury Associated with the Triquetral Dorsal Chip Fracture

• Lee SJ
• Hwang JH
• Kang MS
• Park JW

• KMID: 2063907
• DOI: http://doi.org/10.12671/jkfs.2009.22.3.179

Abstract

PURPOSE: To evaluate the usefulness of wrist arthroscopic examination in patient with persistent pain after the triquetral dorsal chip fracture and also to determine its relationship with TFCC injury in the triquetral dorsal chip fracture patient manifesting persistent pain.
MATERIALS AND METHODS
This study is based on six cases presenting persistent pain in the ulnar aspect after the triqeutral posterior cord fracture that were treated conservatively. Wrist arthroscopy was carried out for all six cases. All were preoperatively and postoperatively evaluated using VAS pain scale, grip power, ulnar grind test, Kleinman shearing test and lunotriquetral ballottment test.
RESULTS
Preoperatively, ulnar grind test yielded positive results in all six cases, Kleiman shearing test proved positive in three cases and lunotriquetral ballottment test yielded positive result in one case. In the arthroscopic findings, synovitis and TFCC injury were detected in all cases, and based on Palmer classification of TFCC injury, type IA was determined in five cases and type ID in one case. Arthroscopic TFCC partial resection and synovectomy were carried out. VAS pain scale improved from an average 8 points preoperatively to 3 points postoperatively. The difference of grip power between the normal and the other side improved from average of 15 lb preoperatively to 5 lb postoperatively. Based on postoperatively physical examination at 6 weeks, all cases yielded negative results in the ulnar grind test and Kleiman shearing test.
CONCLUSION
We think that TFCC injury is one of the causes of persistent pain after triquetral dorsal chip fracture. We recommend an arthroscopic TFCC partial resection as a valuable treatment option.

Keyword

Triquetral dorsal chip fracture; TFCC injury; Wrist arthroscopy; Arthroscopic TFCC partial resection

MeSH Terms

Arthroscopy
Hand Strength
Humans
Physical Examination
Synovitis
Wrist

Figure

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  Fig. 1 Plain x-ray (A, B) and CT (C) of a 45-year-old man show chip fracture of triquetrum and MRI (D) shows TFCC injury.

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  Fig. 2 Arthroscopy shows palmer type Ia, TFCC injury (A) with synovitis (B), and SL ligament injury (C). The (D) shows TFCC after partial resection and debridement.

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  Fig. 3 VAS pain scale shows the degree of the pain was decreased in length of time.

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