16 Open Repair of an Ulnar-Sided Triangular Fibrocartilage Complex Tear

• Approach the ulnocarpal joint and DRUJ through the fifth extensor compartment (Fig. 16-1).
  
• Open the DRUJ capsule with an L-shaped incision, with one limb along the sigmoid notch and one just proximal to the dorsal radioulnar ligament (Fig. 16-2).

Pitfall

Avoid cutting the dorsal radioulnar ligament by beginning the capsulotomy at the proximal aspect of the sigmoid notch.

Fig. 16-1

• Open the ulnocarpal joint through an incision just distal to the dorsal radioulnar ligament and extend it distally along the radial margin of the extensor carpi ulnaris (ECU) sheath (Fig. 16-2).
  
• Inspect the TFCC on its proximal and distal surfaces and determine whether it is repairable (Fig. 16-3).
  
• Prepare the fovea by removing granulation tissue and scar.
  
• Drill two or three holes with a 0.45 in. K-wire from the dorsal aspect of the ulnar neck to the fovea (Fig. 16-4A,B).

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