TFC Surgery (Triangular Fibrocartilage Complex)

Transcript:

Let’s take a look at TFC surgery. The TFC or Triangular Fiber Cartilage is a cartilage in the wrist that’s subject to trauma for many activities that cause a violent twisting motion of the wrist. Weightlifting is common, lifting free weights where they torque the wrist. Next is a torque gun, torquing the wrist against resistance. And finally, from the images, a tennis player. This is one of the top tennis players in the world, actually hurt his wrist from doing this, from hitting a Top Spin that can injure the TFC. This can also occur from lifting luggage off of a rapidly moving conveyor belt or just simply falling on an outstretched wrist can cause this problem.
Let’s look at the anatomy here. The TFC is made up of, is also part of a complex called the TFCC or Triangular Fibrocartilage Complex, which is made up of supporting ligaments of the wrist joint that come off the end of the Ulna bone and this thin disc or cartilage or the TFC which is this disc-like structure here. It’s triangular in shape as we’re going to see. But we, this you can see here a tear within the cartilage. As you can see, both palmar (front) and back views of the distal Ulna on both sides of this image, mostly showing the split in the cartilage.
Now looking at this further, we look at a triangular diagram. It’s a simple diagram right here. If you look at this color line though, this denotes the most common tear that’s present in the majority of cases which is a slit tear going across the base of the triangle here. The distal radius bone would be in this area, the Ulna would be in this area, so it’s a cross-section of that triangle. So what we do surgically to correct this because there’s no good circulation to this area of the cartilage, we go in and simply trim out that cartilage tear and make a big hole so the edges can’t meet so when you rotate the forearm those edges aren’t sawing back and forth on one another causing pain.
Now let’s take a look at the most common way to diagnose a TFC tear or ligament injuries in the wrist, that is an MR or MRI arthrogram, where contrast, which is this white fluid right here, as you can see beautifully on the MRI, is injected into the radio carpal joint here. That should all stay in this joint, but with a tear, as you can see with this arrow right here, there’s an opening in this black cartilage that here’s a TFC. You see this gap, fluid flows into this joint, which shouldn’t happen. That denotes a TFC tear.
The treatment for this is highly successful with minimally invasive arthroscopic surgery. This shows an image taken if we put a scope in through a two-millimeter incision on the back of the wrist. We’re viewing this on a TV monitor in the operating room, just what you’re seeing here. This is the cartilage on the top of the radius bone and then there’s a slit just as I showed you on the diagram, this cartilage tear right here. This is a metal probe we’re putting in through that second incision, a two-millimeter incision on the other side of the wrist, and we’re opening the cartilage tear up to show you. Now what happens is that we put a in place of this probe we put a router, a vacuum cleaner in as you’ll see from this video right here. It’s just sucking out fluid as well as debriding the cartilage into an oval shape as I showed you on that diagram. You can see the Ulna moving right here as the forearm rotates around the radius over the Ulna, and you can see movement. Now let’s take a look at a final image of this debridement. You can see again the probe coming in here. This shows the TFC that’s been debrided or trimmed away. This shows a nice picture of the head of the Ulna and the radius over here.
Now, the second most common type of image of the tear that we’re going to look at is called a peripheral TFC tear. Now this is on the edge of the triangle. This is the most important part because the last tear I showed you had poor circulation, so we trimmed it out. This actually has healing potential because the circulation is good to the edge of the triangle. It’s also very important that this heal adequately because this gives stability to that distal radial ulnar joint. So you can see here on the diagram these little rings or mimic sutures that we’re actually going to place in the wrist joint. But let’s look at a live shot of a patient here. This shows the TFC or the cartilage coming out here peripherally, and you can see the Probe on the far left-hand side there. That shows that this whole thing is being lifted up, denoting an unstable peripheral TFC tear. What we do is actually go then and make a little bit bigger incision over the back of the wrist and we’ll put a suture in as you can see in the next image here. This blue line almost looks like licorice, but it’s actually a suture that’s placed into the wrist joint that anchors it back in place.
Now, after this procedure, the initial procedure, if it’s just a simple debridement procedure, which is present 90% of the time, we simply put the patient in a short brace for about a week and then start therapy. All in all, that’s about a six-week recovery to get back to highly competitive Sports. Now for that peripheral tear, however, it’s about six weeks in a long cast because we want that to heal, and we don’t want to move the wrist too soon. So about six weeks in that long cast above the elbow, and then about two to three months of rehab to return to normal activities. There’s about a 95% success rate with this type of surgery, highly effective. For more on this condition and many other conditions, please visit the Hand & Wrist Institute website.