Ulnar peripheral tears of the triangular fibrocartilage complex: multiplanar approach of injury patterns with a focus on CT arthrography

Abstract

The triangular fibrocartilage complex (TFCC), specifically the distal radioulnar ligaments (DRULs) are the main stabilizing components of the distal radioulnar joint. These ligaments are formed by superficial and deep fibers that are inserted into the distal ulna in the styloid process and fovea, respectively. Therefore, four arms are inserted into the ulna, two superficial and two deep arms. The deep foveal arms are biomechanically more advantageous in maintaining joint stability. For this reason, determining the injury to these fibers is the most critical parameter to define when planning an eventual surgery. Different forces acting on the distal radioulnar joint stretch each of these DRUL components differently. If the various forces acting on these structures are excessive, it can determine an avulsion of the bone insertion. Which components may tear will depend on the predominant mechanism of injury, magnitude, and direction of the traumatic forces acting on the ulnar wrist. The CT arthrography, in case of an injury, can clearly define which component is involved. The purpose of this review was to demonstrate the detailed description of the different components affected and the tear patterns of peripheral ulnar TFCC that can be defined through a multiplanar approach in CT arthrography. This approach has not been previously exposed in the literature. The various injuries described utilizing the multiplanar approach could lead to a better clinical-radiological correlation and a change in patient management.