Tears of the proximal component of the triangular fibrocartilage complex (pc-TFCC) lead to instability in the distal radioulnar joint. The aim of this study was to measure the load-bearing radioulnar distances (RaUls) and to evaluate its diagnostic suitability in patients with pc-TFCC tears.
We retrospectively assessed and compared the lateral wrist radiographs of 61 adult patients with arthroscopically confirmed tears of pc-TFCC with those of a control group of 64 healthy participants. The RaUl was measured on lateral radiographs, and the difference in RaUl (D-value) between load-bearing and nonloading conditions was calculated in the 2 groups. Receiver operator characteristic curves were plotted to determine the diagnostic accuracy and optimal cutoff-score of load-bearing RaUl and RaUl D-value. The diagnostic performance was verified in a validation sample of patients (30 wrists) with pc-TFCC tears and a control group of healthy individuals (30 wrists).
In the training sample, load-bearing RaUls of the affected wrists were higher than the same side of the controls (12.0 mm vs 7.1 mm). The TFCC-injury group showed a significantly higher RaUl D-value than the control group (8.5 mm vs 3.4 mm). Using a receiver operator characteristic curve, the cutoff value of load-bearing RaUl was 10 mm (sensitivity = 97.6%, specificity = 85.7%) and that of RaUl D-value was 6.5 mm (sensitivity = 90.2%, specificity = 78.5%). The areas under the curve of load-bearing RaUl and RaUl D-value were 0.96 and 0.88, respectively. In the test sample, the sensitivity, specificity, and accuracy of RaUl were 0.93, 0.70, and 0.82 and those of RaUl D-value were 0.77, 0.83, and 0.80 respectively.
Load-bearing RaUl measurement is a simple method to diagnose an unstable distal radioulnar joint in patients with TFCC injury. The load bearing RaUl of >10 mm or RaUl D-value of >6.5 mm can be used to differentiate TFCC injuries and showed acceptable accuracy.
Type of study/level of evidence
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Published online: March 02, 2022
Accepted: January 7, 2022
Received: February 27, 2021
A.Y., X.Z., and H.Z. contributed equally to the manuscript.
No benefits in any form have been received or wills be received by the authors related directly or indirectly to the subject of this article.
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
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