Outcomes of Below-Elbow Versus Above-Elbow Immobilization in the Management of a Partial Triangular Fibrocartilage...

Background The triangular fibrocartilage complex (TFCC) is a crucial biomechanical structure that supports the distal radioulnar joint (DRUJ), forearm rotation, and load transfer along the ulnar aspect of the wrist. Conservative treatment is the preferred approach for managing stable TFCC injuries, but the techniques of immobilization remain a topic of debate. This study aims to evaluate whether above-elbow immobilization provides better pain relief, functional recovery, and fewer complications than below-elbow immobilization in the conservative treatment of partial TFCC tears without DRUJ disruption. Materials and methods A total of 52 patients treated at R.L. Jalappa Hospital and Research Centre, Kolar, India, from February 2024 to January 2025, who had magnetic resonance imaging (MRI)-confirmed partial tears of the TFCC without DRUJ instability, were retrospectively reviewed. The patients were divided into two groups: Group A (n = 26) was managed using below-elbow immobilization with a slab, splint, or cast, while Group B (n = 26) was managed using above-elbow immobilization with a slab, splint, or cast. Initial immobilization was done for six weeks, followed by a two-week period of wearing a wrist brace. After that, range of motion (ROM) exercises were performed over a period of seven to eight weeks, along with a structured rehabilitation program from weeks 9 to 16. Outcome measures of pain were assessed using the Visual Analog Scale (VAS), upper limb function using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and wrist-specific outcomes using the Patient-Rated Wrist Evaluation (PRWE) score at baseline, and at 6, 12, and 24 weeks, respectively. Complications were recorded throughout the study period.  Results At each follow-up visit, Group B exhibited lower VAS (0.9 vs. 1.7), DASH (10.8 vs. 13.4), and PRWE scores (14.2 vs. 17.6). Group A had 10 patients (38.5%) with complications, whereas Group B had seven patients (26.9%) with complications. Conclusion In cases of partial tears of the TFCC without DRUJ disruption, the clinical outcomes with above-elbow immobilization are superior to those with below-elbow immobilization over a 24-week follow-up. Based on these findings, limiting supination and pronation of the forearm in the early stage is crucial for effective healing and functional recovery in partial TFCC injuries, and a tailored treatment plan, along with structured rehabilitation, is essential.