Houston Methodist. Leading Medicine

Wrist FAQ

Question:

Years ago I received dire warnings that my wrist fracture and a triangle ligament tear would probably cause arthritis. I had the wrist in a cast but they didn't fix the torn ligaments. So far, I haven't had any problems like that. I know my grip isn't as strong on that side but I have learned how to get around that. What happens to other people with this kind of problem who don't have surgery to fix the torn ligaments?

Answer:

You will probably be interested in the results of a study done by several hand surgeons from Sweden. They took a look at what happened to a group of patients with a displaced distal radial fracture that also caused a triangular fibrocartilage complex (TFCC) tear. The fracture was treated but the damaged soft tissue was not. These patients were treated for the fracture 10 to 15 years ago when the treatment protocol at that time did not call for TFCC repair or reconstruction. Wrist pain at rest and with activities along with loss of strength and decreased function are disabling problems associated with triangular fibrocartilage complex (TFCC) tears. The triangular fibrocartilage complex (TFCC) suspends the ends of the radius and ulna bones over the wrist. It is triangular in shape and made up of several ligaments and cartilage. The TFCC makes it possible for the wrist to move in six different directions (bending, straightening, twisting, side-to-side). It stabilizes the distal radioulnar joint while improving the range of motion and gliding action within the wrist. The question they asked (like yours) was, "What happens to untreated TFCC injuries?" This is called the natural history of a condition. Certainly, there is always a concern for arthritis developing after a traumatic injury. But does it? Are patients with untreated TFCC tears still unstable years later? To find out, they contacted a group of patients who met this criteria. Through telephone interviews, examinations, and X-rays, they were able to see some important trends. First, there did not appear to be any direct link between wrist joint laxity present from the lack of the TFCC tension and subsequent arthritis. There were some patients who developed wrist arthritis but not any more than the general adult population who don't have wrist injuries. The group as a whole did have some weakness in grip strength but this was not disabling. About half the group had joint laxity (looseness) but not instability (joint slippage). Only one patient was unstable enough to have surgery. The others seemed to manage and adapt without further problems (again, very much like your report of yourself). Patients who only had a partial tear did have better overall results compared with those who had a complete TFCC tear. The authors concluded from this study there was not enough evidence to suggest aggressive surgical treatment of TFCC tears when this type of associated soft tissue injury occurs along with a distal radius (wrist) fracture. However, the number of patients in the study was small (38) so they do advise further (larger) studies need to be conducted in order to further confirm or clarify their own findings. Ante Mrkonjic, MD, et al. The Natural Course of Traumatic Triangular Fibrocartilage Complex Tears in Distal Radial Fractures: A 13-15 Year Follow-Up of Arthroscopically Diagnosed but Untreated Injuries. In The Journal of Hand Surgery. August 2012. Vol. 37A. No. 8. Pp. 1555-1560.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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