Name of the Procedure:

Arthrotomy of the Distal Radioulnar Joint with Repair of Triangular Fibrocartilage Complex (TFCC)

Summary

Arthrotomy of the distal radioulnar joint involves surgically opening the joint to access and repair the triangular fibrocartilage complex (TFCC). This procedure is typically used to restore stability and function to the wrist when the TFCC is damaged.

Purpose

The procedure addresses the instability and pain in the wrist due to TFCC tears or injuries. The goal is to alleviate symptoms, improve wrist function, and prevent further joint damage.

Indications

• Persistent pain and swelling in the wrist
• Difficulty rotating the wrist
• A history of injury or trauma to the wrist
• Failed conservative treatments (e.g., physical therapy, medications)
• Positive diagnostic tests indicating TFCC damage

Preparation

• Fasting for at least 8 hours before surgery
• Adjustments to medications as directed by the physician
• Pre-operative imaging (e.g., MRI, X-rays) and blood tests

Procedure Description

1. The patient is administered regional or general anesthesia.
2. An incision is made over the distal radioulnar joint on the wrist.
3. The joint capsule is carefully opened to expose the TFCC.
4. Damaged portions of the TFCC are identified and repaired using sutures.
5. The joint capsule is then closed, followed by the skin incision.
6. A sterile dressing is applied to the surgical site.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic surgeon or hand surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologist

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Nerve or blood vessel injury
• Stiffness or decreased range of motion in the wrist
• Recurrence of symptoms or failure to relieve pain

Benefits

• Reduced or eliminated wrist pain
• Improved stability and function of the wrist
• Enhanced ability to perform daily activities without discomfort
• Prevention of further joint damage

Recovery

• Keep the wrist immobilized with a splint or cast for several weeks
• Follow post-operative instructions for wound care and activity restrictions
• Gradual return to normal activities, guided by a physical therapist
• Full recovery and return to activities can take several months
• Follow-up appointments to monitor healing progress

Alternatives

• Non-surgical treatments (e.g., physical therapy, wrist braces, corticosteroid injections)
• Arthroscopy (minimally invasive surgery) as opposed to open arthrotomy
• Pros: Less invasive options often have shorter recovery times.
• Cons: May not be effective for severe or complex cases.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-operatively, the patient may experience some discomfort and swelling, which can be managed with prescribed pain medications. Follow-up care includes rest, gradual rehabilitation exercises, and regular check-ups to ensure proper healing.