The Role of Initial Conservative Treatment for Suspected Triangular Fibrocartilage Complex Injuries in Children and...

Injuries to the triangular fibrocartilage complex (TFCC) are a common cause of ulnar-sided wrist pain in children and adolescents. Although outcomes of surgical treatment have been reported in this population, the indications for surgical treatment and the role of conservative therapy have not been elucidated. This study aimed to determine the results of nonsurgical treatment of suspected TFCC tears in children and adolescents and identify factors associated with conversion to surgical treatment.

A retrospective review of pediatric patients treated initially nonoperatively for suspected TFCC tears was performed. Demographic data, injury mechanism, radiographic measurements, hand therapy notes, need for surgery, and patient-reported outcome measures were collected. Based on whether or not surgery was required, patients were divided into 2 groups: conservative only (CO) and conservative to surgery (CS). These groups were compared with respect to patient, injury, and treatment characteristics.

Thirty-six total patients were included, of whom 13 were treated successfully with nonsurgical treatment (CO group), and 23 required conversion to surgical treatment (CS group), for an overall success rate of conservative treatment of 36%. Duration of symptoms prior to treatment was significantly shorter for the CO group (median 13 days) than for the CS group (median 73 days). All patients with successful nonsurgical management were treated with an above-elbow cast. Patient-reported outcomes did not differ between the groups at the conclusion of treatment.

This study found conservative treatment to be successful in only a third of children and adolescents with a suspected TFCC tear, and only when above-elbow immobilization was used after a relatively short duration of symptoms. For patients with a longer duration of symptoms or persistent symptoms following above-elbow immobilization, surgery can be offered without a trial of further conservative treatment.

Therapeutic III.