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TFC Surgery (Triangular Fibrocartilage Complex)

One of the most important structures in the wrist is the triangular fibrocartilage, or TFC. This, in turn, is part of the TFCC or triangular fibrocartilage complex, which is comprised of the TFC itself and several ligaments. The whole complex stabilizes the ulnocarpal and distal radioulnar joints. The TFC is most commonly injured by being twisted or torqued, as can occur when lifting weights or other heavy objects in awkward wrist positions. Falling on the wrist in an outstretched position or certain sports-related injuries can also lead to injury of the TFC. The part of the TFC closest to the radius is not provided with good bloodflow, and as such is a delicate structure prone to injury and less likelihood of healing. When a tear occurs, the surgeon will cut out a larger hole to reduce contact and irritation. This does not have as much potential for structural instability because of its location on the TFC. An MR Arthrogram is the most effective diagnostic tool in TFC tears because it uses contrast to indicate whether or not there is a tear in the cartilage. This is especially useful because in standard MRIs the findings may indicate a normal TFC in 30% of cases, even if that is not true. Arthroscopic surgery is generally the best way of both determining and treating an injury to the TFC. The arthroscope is inserted in a small hole in the wrist and then a probe is used to find and investigate the tear. At this point a small vacuum suction device is used to remove the ragged edges of the tear and the scar tissue, reducing irritation and inflammation. Tears at the edge of the TFC have a higher likelihood of healing because it has better blood flow, and can be more easily repaired, especially by suturing the TFC. This injury can cause instability, and so must be treated quickly to avoid complications. There is a 95% success rate with TFC surgery, with 90% of those surgeries being the debridement rather than the suturing. Generally, recovery time is about six weeks, including a week of splinting after surgery and then subsequent therapy to return function. The latter surgery requires a longer period of splinting, up to six weeks, and then two subsequent months of therapy.