TFC Surgery (Triangular Fibrocartilage Complex)

• Video ID: p1lErfNYcck
• URL: https://www.youtube.com/watch?v=p1lErfNYcck
• Uploaded: 2014-11-01
• Duration: 338s
• Views at capture: 120161
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Description (channel copy)

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.

Transcript

let's take a look at TFC surgery the TFC or Tri triangular fiber cartilage is a cartilage in the wrist that's subject to trauma for many activities that cause a that cause a violet twisting motion of the wrist weightlifting is a common lifting free weights where they torque

the wrist next is a uh torque gun torquing the wrist against resistance and finally uh from the images a tennis player this is one of the top tennis players in the world actually hurt his rist from doing this from hitting a Top Spin that can injure the TFC this can

also occur from lifting luggage off of a rapidly U moving conveyor belt or just simply falling on an outstretch 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 Ona bone and this thin disc or cartilage or the TFC which is this dis- 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 pal front and back views of the distal Ona on both sides of this image mostly showing the split and the cartilage now looking at this further uh we look at a at a triangular diag it's a simple diagram right here if you look at this color

line though this denotes the most common Terror that's present in the majority of cases which is a slit tear going across the uh base of the of the triangle here the distal radius radius bonus would be in this area the Onna 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

seawing back and forth on one another causing pain now let's take a look at the most common way to diagnose a TFC Terror or ligament injuries in uh in the wrist that's 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 radiocarpal joint here that should all stay in this joint but with a tear as you can see with this Arrow right here there's a 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 now the treatment for this is uh highly successful with minimally invasive arthoscopic surgery this shows an image taken uh if we put a scope in through a two 2 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 putting in through that second incision

2mm 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 rotor router a vacuum cleaner in as you'll see from this video right here it's just sucking out fluid as well as

debring the cartilage into an oval shape as I showed you on that diagram you can see the Ona moving right here as the forearm rotates around the radius around the over the radius over the Ona and you can see movement now let's take a look at a final image of this debent you can

see again the probe coming in here this shows the TFC that's been debed or trimmed away this shows a nice picture of the head of the Ona and the radius over here now the second most common type of um of image that 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 before the the last tier 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 owner joint so you can see here on the diagram these little Rings or uh 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 a a suture that's placed into the wrist joint that anchors that back in place now after

this procedure uh the initial procedure uh if it's just a simple uh debent 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 back to highly

competitive Sports now for that peripheral tear however it's about a uh 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 Hanah wrist Institute website