Toshiyasu NAKAMURA

In this authoritative lecture, Dr. Nakamura outlines the current TFCC concept.

The triangular fibrocartilage complex (TFCC) plays an essential role in the stability of the distal radioulnar joint (DRUJ) stability. In this lecture, Dr. Nakamura presents the surgical approach to the TFCC.

Caroline Leclercq submits a particularly difficult clinical case to a group of international experts in wrist surgery. This is the case of a 17-year-old girl who presented with midcarpal instability secondary to the treatment of a fractured scaphoid, with intact scapholunate ligament. The experts' feedback demonstrate how intricate this kind of situation can be.

The TFCC is an essential structure in the stability of the distal radio-ulnar joint (DRUJ). What we took for a simple suspensory ligament has actually become a complex structure than previously thought since the work of Palmer in 1981. Some members of the EWAS, first and foremost Toshiyasu Nakamura, has helped to better understand this essential component as well as the damage it may suffer. Thanks to Andrea Atzei, Francisco Del Pinal and Tommy Lindau, the TFCC is now a well understood and well-known entity. Having them together in a round table on this topic answering a flow of questions asked by our two famous chairmen, Diego Fernandez and Laurent Obert, allows to better understand the problems caused by the lesion of this structure.

Since Nakamura's outstanding works in 2000, followed by Atzei's more recent works, Triangular FibroCartilage Complex (TFCC) tears have turned out to be more complex than previously described by Palmer. In fact, the medial insertion of the TFCC is twofold: classic distal peripheral, as described by Palmer, and proximal into the distal fovea of the ulnar head with, when injured, instability of the distal radioulnar joint. This lecture reports the current comprehension of the TFCC lesion and the description of a new technique for transosseous reinsertion in case of proximal avulsion.