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Advantages of Open Repair of a Foveal Tear of the Triangular Fibrocartilage Complex Via a Palmar Surgical Approach

Moritomo, Hisao MD, PhD

Techniques in Hand & Upper Extremity Surgery: December 2009 - Volume 13 - Issue 4 - p 176-181
doi: 10.1097/BTH.0b013e3181bd8319
Techniques
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Foveal tears of the triangular fibrocartilage complex (TFCC) can be repaired via a palmar surgical approach. Unlike the dorsal approach, in this method the floor of the extensor carpi ulnaris tendon subsheath and the dorsal superficial limb of the radioulnar ligament do not hinder the view of the fovea. Patients with a fresh or chronic TFCC foveal tear and a positive ulnar fovea sign with its dorsal styloid insertion remaining intact are candidates for this procedure. During operation, the shoulder is positioned at 90 degrees of abduction, and the elbow is flexed at 90 degrees on an arm board. A 4 cm curved skin incision along the flexor carpi ulnaris tendon is made on the anterior aspect of the ulnar fovea. The ulnar fovea is exposed through a transverse capsulotomy of the distal radioulnar joint. The ulnocarpal joint distal to the TFCC is also exposed between the extensor carpi ulnaris tendon subsheath and the ulnotriquetrum ligament. After curettage of the scar tissues at the fovea, the lifted TFCC is sutured onto the fovea using a suture anchor technique.

Department of Orthopaedic Surgery, Osaka University, Suita, Osaka, Japan

No funding was received for this work.

Address correspondence and reprint requests to Hisao Moritomo, MD, PhD, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. E-mail: moritomo@ort.med.osaka-u.ac.jp.

© 2009 Lippincott Williams & Wilkins, Inc.