Review Question - QID 4700

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Triangular Fibrocartilage Complex (TFCC) Injury Treatment Operative QID: 4700 (OBQ13.65)

QID 4700 (Type "4700" in App Search)

A 30-year-old male laborer sustained a right wrist injury 9 months ago. He continues to have symptoms of recurrent ulnar-sided wrist pain that impairs his ability to work. An MRI is performed and shows a triangular fibrocartilage complex (TFCC) injury. Which of the following is an indication to combine a Wafer procedure with arthroscopic TFCC debridement?

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Ulnar styloid fracture

145/6235

Radial styloid fracture

29/6235

2 mm of positive ulnar variance and ulnocarpal impingment

91%

5661/6235

2 mm of negative ulnar variance and radiocarpal joint arthritis

237/6235

Scapholunate ligament injury

102/6235

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A Wafer procedure is indicated for positive ulnar variance and symptomatic ulnocarpal impingement associated with degenerative TFCC tears.

Ulnar impaction syndrome and triangular fibrocartilage complex (TFCC) injuries are relatively common causes of ulnar-sided wrist pain. Positive ulnar variance causes increased contact pressures between the lunate and the ulnar head. The Wafer procedure removes 2-4 mm of distal ulnar head to reduce ulnar variance to neutral or negative. This is thought to reduce ulnar impaction and decrease pain.

Faber et al. examined the role of MRI in wrist injuries. They showed that the sensitivity and specificity to detect TFCC tears using MRI is approximately 80%. They conclude that there is no supporting evidence for routine MRI's for patients with non-specific ulnar-sided wrist pain.

Illustration A is a coronal view MRI (without arthrogram) of the right wrist that shows a TFCC tear (blue arrow) with positive ulnar variance. Illustration B shows a series of images showing a TFCC tear on MRI and intra-operatively.

Incorrect Answers:
Answers 1,2,4,5: Arthroscopic Wafer procedure is indicated for positive ulnar variance and ulnocarpal impingement associated with TFCC tears. This procedure uses the central TFCC tear to access the distal ulna with the arthroscope. The pathological findings supplied in the other answer options are not indications for this surgical procedure.

ILLUSTRATIONS: