Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea.
Clin Orthop Surg. 2021 Mar;13(1):105-109. doi: 10.4055/cios20117. Epub 2021 Feb 15.
Triangular fibrocartilage complex (TFCC) injury is common in distal radius fractures. The purpose of this study was to compare the conservative and surgical treatments of TFCC injury of the wrist associated with distal radius fractures.
A retrospective study was conducted on 39 patients who received treatment for TFCC injury with distal radius fractures. All patients were treated using a volar locking plate for distal radius fractures. Twenty-six patients who received conservative treatment for TFCC through long arm splinting were classified into group 1, and 13 patients who received surgical treatment for TFCC were classified into group 2. The splint was maintained for 6 weeks in both groups. For clinical evaluation, the range of motion (ROM) of the wrist joint, patient-rated wrist evaluation (PRWE) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, and grip strength were measured. Distal radioulnar joint (DRUJ) stability was evaluated through a stress load test and graded between grade 0 and 3 intraoperatively after fixation and at the final follow-up.
In group 1, the average DASH score was 11.1 ± 4.4, the average PRWE score was 10.2 ± 4.6, the grip strength was 89.4% relative to the unaffected side, the average ROM of the wrist joint was 65° ± 7.0° for extension, 51.5° ± 8.1° for flexion, 86° ± 5.1° for supination, and 85° ± 5.2° for pronation, and DRUJ stability at the final follow-up was grade 0 in 58.62%, grade 1 in 31.03%, grade 2 in 10.34%, and grade 3 in 0%. In group 2, the average DASH score was 13 ± 5.0, the average PRWE score was 12.4 ± 3.7, the grip strength was 87.3% relative to the unaffected side, and the average ROM of the wrist joint was 60° ± 9.8° for extension, 53.1° ± 7.0° for flexion, 85° ± 5.3° for supination, and 86.8° ± 4.5° for pronation. At the final follow-up, DRUJ stability was grade 0 in 66.67%, grade 1 in 25%, grade 2 in 8.3%, and grade 3 in 0%. The 2 groups showed no statistically significant differences in DASH score, PREW score, grip strength, ROM, and final follow-up DRUJ stability.
There were no statistically significant differences in the clinical outcomes between the surgical and conservative treatment groups. Therefore, when normal radiological indices are achieved after treatment of distal radius fractures, DRUJ stability can be obtained by conservative treatment.
三角纤维软骨复合体（TFCC）损伤在桡骨远端骨折中较为常见。本研究旨在比较腕关节 TFCC 损伤伴桡骨远端骨折的保守治疗和手术治疗。
对 39 例接受桡骨远端骨折伴 TFCC 损伤治疗的患者进行回顾性研究。所有患者均采用掌侧锁定钢板治疗桡骨远端骨折。26 例接受 TFCC 保守治疗（长臂夹板固定）的患者分为组 1，13 例接受 TFCC 手术治疗的患者分为组 2。两组均用夹板固定 6 周。临床评估包括腕关节活动度（ROM）、患者自评腕关节评估（PRWE）评分、上肢残疾量表（DASH）评分和握力。在固定后和最终随访时，通过应力负荷试验评估下尺桡关节（DRUJ）稳定性，并在术中分级为 0 级至 3 级。
在组 1 中，DASH 评分平均为 11.1±4.4，PRWE 评分平均为 10.2±4.6，握力为健侧的 89.4%，腕关节 ROM 平均为伸展 65°±7.0°，屈曲 51.5°±8.1°，旋前 86°±5.1°，旋后 85°±5.2°，DRUJ 在最终随访时的稳定性为 0 级 58.62%，1 级 31.03%，2 级 10.34%，3 级 0%。在组 2 中，DASH 评分平均为 13±5.0，PRWE 评分平均为 12.4±3.7，握力为健侧的 87.3%，腕关节 ROM 平均为伸展 60°±9.8°，屈曲 53.1°±7.0°，旋前 85°±5.3°，旋后 86.8°±4.5°。在最终随访时，DRUJ 稳定性为 0 级 66.67%，1 级 25%，2 级 8.3%，3 级 0%。两组在 DASH 评分、PREW 评分、握力、ROM 和最终随访 DRUJ 稳定性方面无统计学差异。
手术治疗和保守治疗组的临床结果无统计学差异。因此，在治疗桡骨远端骨折后获得正常影像学指标时，可通过保守治疗获得下尺桡关节稳定性。
