Management of chronic peripheral tears of the triangular fibrocartilage complex

Injury to the triangular fibrocartilage is recognized with increasing frequency as a major source of pain on the ulnar side of the wrist. Traumatic separation of the well-vascularized medial insertion of the triangular fibrocartilage complex at the fovea of the ulnar styloid is less common than attritional perforation of the central hypovascular articular disc. Thirteen patients with traumatic separation of the triangular fibrocartilage complex from its peripheral origin (eleven with documented single-episode antecedent trauma) had anatomic reconstitution by surgical reattachment to the ulna. After postoperative rehabilitation, return to essentially normal painless activities was reached in eight of eleven patients with follow-up greater than one year. Two of the three unsatisfactory results responded well to subsequent surgery (distal ulna resection; ulnar shortening osteotomy); one patient has been unable to return to competitive gymnastics and seeks no further treatment.