Radial avulsion of the triangular fibrocartilage complex in acute wrist trauma: A new technique for arthroscopic repair

The advantages of arthroscopically assisted treatment of intraarticular distal radius fractures, especially the detection of additional carpal lesions, also focus attention on special surgical techniques for operating on these injuries within the same session. When we consider the biomechanical situation, various kinds of triangular fibrocartilage complex (TFCC) lesions, and their arthroscopic aspects, there are probably two possibilities for surgical treatment that are similar to arthroscopic meniscal surgery: resection of flap tears and the refixation of peripherally disinserted TFCC. Avulsions from the ulnar styloid or from the ulnar collateral ligament and the extensor carpi ulnaris tendon can easily and satisfactorily be treated by convenient arthroscopic suture techniques, whereas the reattachment of the triangular disc in the sigmoid notch is very tricky. This problem is solved by a recently developed procedure using the so-called T-Fix-device (Acufex), which provides the possibility of transosseus refixation by closed arthroscopic procedure and therefore guarantees the principle of minimal invasive surgery.