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A system of tissues (cartilage and ligaments) is responsible for stabilizing the wrist, for its easy movement and shock absorption, like a shock absorber does. The so-called triangular fibrocartilage complex (TFCC), or, briefly, the triangular fibrocartilage, is located on the inside of the wrist between the lower end of the ulna and the bones of the wrist, under the little finger of the hand. It consists of the triangular fibrocartilage discus (TFC), the peripheral cartilage which is analogous to the meniscus of the knee, the radioulnar ligaments (RUL’s), and the sheath of the extensor carpi ulnaris.

Disruptions, namely, the discontinuity of the triangular fibrocartilage, may be traumatic (a fall upon the stretched hand) or of a degenerative type, due to overuse, or even a result of the normal aging process. Moreover, it is a concomitant lesion regarding 80% of the peripheral fractures of the radius, or may be attributed to an anatomical variation of the ulna (the ulna may be longer than the radius).

High-risk groups for a traumatic disruption include young and high-performance athletes – this specific injury often appears in boxers, tennis players and artistic and rhythmic gymnastics athletes. On the contrary, degenerative lesions occur after the age of 40, without a history of injury. They are distinguished from a detachment from the radius or the ulna, and a central or palmar disruption.

In cases of patients with too severe disruptions, or with disruptions which, even after their conservative treatment, continue to cause wrist pain, surgical treatment is an effective option. Open techniques with large incisions are selected to repair more complex disruptions, depending on lesions in the ligaments and cartilage. However, as with all joints, arthroscopy is the procedure of choice, mainly because the two or three incisions made do not exceed 5 millimeters, resulting in less postoperative pain and faster recovery.

During surgery, the arthroscope shall give the surgeon a clear picture of the joint and it shall allow him to recognize the type of disruption. Regarding the central type and acute palmar lesions, a cleaning (debridement) is performed, so the body can heal itself. In cases where the triangular fibrocartilage has been detached from the radius, it is fixed with special sutures, and if it has been detached from the ulna, a cleaning is attempted. A cleaning is also performed in degenerative-type disruptions.

Postoperatively, the wrist should remain at a vascular position for two to three days, with a period of immobilisation ranging from 2 to 6 weeks. Thence, a 6-8 week physical recovery and strengthening programme is followed, and the doctor usually recommends that the patient should not drive for at least two months.

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