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Abstract
We present a series of eight patients who underwent wrist arthroscopy for presumed solitary tears of the triangular fibrocartilage (TFC) and were, instead, found to have combined 1A (central tear) and 1B (ulnar avulsion) tears. The Palmer Classification does not currently categorize this combined pattern. All but one patient had a traumatic injury. Each subject had preoperative radiographs and MRI scans. TFC tears were evident on all MRI scans, though only one was suggestive of a combined tear pattern. Surgical management included arthroscopic central tear debridement and ulnar peripheral repair. Average follow-up was 22 months. Grip strength in the affected hand improved from 16% deficit as compared to the unaffected side, to 3.5% deficit postoperatively (p = 0.003), and visual analog scores (VAS) decreased from an average of 7.1/10 preoperatively to 2.3/10 postoperatively (p < 0.001). There was no statistically significant change in wrist range of motion (ROM), however. Arthroscopic debridement of the central perforation (1A lesion) with concomitant repair of the ulnar detachment (1B lesion) resulted in functional and symptomatic improvement. This combined 1A/1B TFC injury is not reliably diagnosed preoperatively and should be considered a new subset in the Palmer classification, as this will raise awareness of its presence and assist in preoperative planning of such lesions.
The triangular fibrocartilage complex (TFCC) is the main stabilizer of the distal radioulnar joint (DRUJ).1 Injury to the TFCC is a common cause of ulnar sided wrist pain. Palmer devised a classification system of traumatic and degenerative lesions of the TFCC, which has contributed significantly to the understanding of this injury and its treatment.2 There are four traumatic subtypes in this classification scheme. Class 1A lesions describe central tears or perforations of the avascular articular disk, which is commonly referred to as the Triangular Fibrocartilage (TFC). It is important to note the difference in terminology, as the TFCC refers to the entire complex, including the volar and dorsal radio-ulnar ligaments, ulnar collateral, ulnocarpal ligaments, as well as the articular disk. Thus, to avoid confusion, the TFC will henceforth be referred to as the articular disk, whereas the entire complex will be referred to as the TFCC. When symptomatic, these lesions are typically managed with arthroscopic debridement.3,4 Class 1B lesions represent traumatic avulsions of...