Arthroscopic Triangular Fibrocartilage Complex Repair Research Articles

The role of arthroscopic triangular fibrocartilage complex repair in a case of bilateral Galeazzi fracture-dislocation

This report presents the case of a 23-year-old man with bilateral distal one-third radial shaft fractures and associated distal radioulnar joint disruption, known as Galeazzi fractures, resulting from a fall from a kickboard. After open reduction and plate internal fixation for both radial shafts, the radioulnar joints remained unstable on both sides. We performed arthroscopic repair of the triangular fibrocartilage complex on the left side and used a short arm splint to immobilize the right side. At the 6-month postoperative follow-up, the patient reported mild stiffness in the left wrist, although both sides showed a full range of motion and distal radioulnar joint stability. In conclusion, when achieving anatomic reduction and stable fixation of the radial shaft in a Galeazzi fracture, favorable results can be achieved without additional surgical treatment, even if the distal radioulnar joint is unstable during surgery.

Comparative Analysis of Treatment Outcomes: Modified Ulnar Gutter Slab vs. Sugar Tong Slab for Distal Radioulnar Joint Instability Following Triangular Fibrocartilage Complex Repair.

The standard treatment for distal radioulnar joint (DRUJ) instability involves repairing the triangular fibrocartilage complex (TFCC) and immobilizing the joint with a sugar tong slab, but this can cause elbow stiffness. To address this, a modified ulnar gutter slab was designed to enhance elbow mobility during immobilization. A prospective randomized controlled trial was conducted on 23 DRUJ instability patients who underwent arthroscopic TFCC repair. Two post-operative splinting techniques were compared: the modified ulnar gutter slab and the sugar tong slab. The assessment included the Disabilities of Arm, Shoulder, and Hand (DASH) score; elbow, forearm, and wrist range of motion (ROM); post-operative DRUJ stability; and complications. DASH scores at 4 and 6 weeks were not significantly different. However, the modified ulnar gutter slab improved elbow extension range of motion at 4 weeks (extension lag: 20.0 vs. 6.5 in the sugar tong group) (p = 0.011). Post-operative DRUJ stability was comparable between the two groups. Notably, one patient in the sugar tong slab group experienced complex regional pain syndrome (CRPS). The modified ulnar gutter slab offers a post-operative alternative after TFCC repair. It effectively immobilizes forearm and wrist motion while enhancing elbow mobility, potentially reducing post-operative elbow stiffness.

Minimal invasions: is wrist arthroscopy supported by evidence? A systematic review and meta-analysis.

Wrist arthroscopy is used increasingly, but its benefits and harms are unclear. This systematic review aimed to identify all published randomized controlled trials on wrist arthroscopy and synthesize the evidence of the benefits and harms of wrist arthroscopic procedures. We searched CENTRAL, MEDLINE, and Embase for randomized controlled trials comparing wrist-arthroscopic surgery with corresponding open surgery, placebo surgery, a non-surgical treatment, or no treatment. We estimated the treatment effect with a random effect meta-analysis using patient reported outcome measure (PROM) as primary outcome where several studies assessed the same intervention. Of 7 included studies, none compared wrist arthroscopic procedures with no treatment or placebo surgery. 3 trials compared arthroscopically assisted reduction with fluoroscopic reduction of intra-articular distal radius fractures. The certainty of evidence was low to very low for all comparisons. The benefit of arthroscopy was clinically unimportant (smaller than what patients may consider meaningful) at all time points. 2 studies compared arthroscopic and open resection of wrist ganglia, finding no significant difference in recurrence rates. 1 study estimated the benefit of arthroscopic joint debridement and irrigation in intra-articular distal radius fractures, showing no clinically relevant benefit. 1 study compared arthroscopic triangular fibrocartilage complex repair with splinting in distal radioulnar joint instability in people with distal radius fractures, finding no evidence of benefits for repair at the long-term follow-up but the study was unblinded, and the estimates imprecise. The current limited evidence from RCTs does not support benefits of wrist arthroscopy compared with open or non-surgical interventions.

Arthroscopic Treatment Results of Triangular Fibrocartilage Complex Tears in Adolescents: A Systematic Review

Introduction: Injury to the triangular fibrocartilage complex (TFCC) may cause chronic wrist pain and instability if left untreated. The current literature of adult cases suggests that arthroscopic treatment offers favorable outcomes and is associated with a low complication rate. This systematic review evaluated the outcomes of arthroscopic TFCC surgery in adolescents. Materials and Methods: A PRISMA-guided literature search of PubMed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Cochrane Clinical Answers was conducted in May 2020. All studies reporting on (1) arthroscopic TFCC repair or debridement in (2) patients under the age of 19 years with (3) a minimum case number of four patients were extracted by two independent observers. The level of evidence of each study was assessed according to the Oxford Centre for Evidence-Based Medicine, and study quality was graded according to the Modified Coleman Methodology Score and the MINORS criteria. Clinical outcome scores, functional parameters, and any complications were reviewed. Results: The selected search terms initially resulted in a total of 986 possible articles. The authors eventually identified eight papers (all LoE IV) for inclusion in this systematic review. A total of 254 patients with verified TFCC tears and a mean age of 16 years (range, 7–19) received arthroscopic repair (162 patients, 67.1% of total) or debridement (77 patients, 29.7% of total). Arthroscopic treatment resulted in low pain levels, high patient satisfaction, and a fast return to sport. Complications overall were sparse and consisted mainly of persistent wrist pain (n = 31) and temporary paresthesia (n = 6) of the dorsal sensory branch of the ulnar nerve. Recurrent tears were sparse, with only four reported cases due to sports participation. Conclusion: Wrist arthroscopy is a reliable surgical option for treating TFCC tears in adolescents. The results obtained are comparable to those published in the literature. However, the variety of repair techniques and the low level of evidence across all included articles demand further prospective studies.

Short-term effect of electroacupuncture on rehabilitation after arthroscopic triangular fibrocartilage complex repair: a randomised study

BackgroundElectroacupuncture (EA) alleviates chronic pain and acute postoperative pain after several surgical procedures. However, whether EA facilitates postoperative functional recovery after arthroscopic surgery has yet to be determined. This study investigated the short-term effect of EA on a rehabilitation course after arthroscopic triangular fibrocartilage complex (TFCC) repair.MethodsForty-two patients undergoing arthroscopic TFCC repair were randomised to an EA group (n = 19) or control group (n = 23). In the EA group, patients received EA treatment and standard active rehabilitation for 4 weeks. In the control group, patients received standard active rehabilitation for 4 weeks. At the end of the treatment and at the follow-up visit 4 weeks after the treatment, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, wrist range of motion (ROM), handgrip strength, and key pinch strength were collected and analysed.ResultsThe EA group improved significantly than the control group in terms of DASH scores, all wrist motion arcs, and key pinch strength (P < 0.05) at the end of the 4-week treatment and the follow-up visit another 4 weeks later.ConclusionPatients treated with 4 weeks of EA after the arthroscopic TFCC repair had better wrist ROM and DASH scores than patients of control group

Open and Arthroscopic Triangular Fibrocartilage Complex (TFCC) Repair.

Triangular fibrocartilage complex (TFCC) tears, whether acute or chronic, can result in persistent ulnar-sided wrist pain. Although diagnosis and nonsurgical management of TFCC tears is well described, there remains ongoing discussion about the optimal surgical technique, specifically open or arthroscopic. This article reviews the most up-to-date literature regarding TFCC injury including demographics, risk factors for TFCC injury, classification of acute and chronic TFCC tears, history and physical examination, appropriate diagnostic imaging, surgical indications, pertinent surgical anatomy, open and arthroscopic TFCC repair, fixation biomechanics and techniques, postoperative rehabilitation, and clinical outcomes.

Arthroscopic triangular fibrocartilage complex repair: A biomechanical comparison of anchor and pull-out techniques in Atzei type II lesions.

Several open and arthroscopic techniques for repair triangular fibrocartilage complex (TFCC) tears have been used. The aim of this study, using a cadaveric model, was to compare the biomechanical resistance to the pronosupination movement of arthroscopic repair with anchor and pull-out techniques in TFCC tears of Atzei type II lesions. Eighteen forearms of cadaveric specimens were evaluated arthroscopically, of which 12 were selected according to the inclusion criteria. All specimens were injured with an Atzei type II lesion and were repaired arthroscopically. Six forearms were repaired using the anchor technique and the other six with the pull-out technique. To assess the biomechanical resistance of the repair, the forearms were tested to 300 cycles of 160° pronosupination. Two evaluators independently assessed the repair status every 10 cycles and the modified Desai classification was used to verify the presence of failure. The mean failure of the repair occurred at 41.6 cycles (SD 7.5) for the pull-out technique and at 28.3 cycles (SD 9.8) for the anchor technique, showing a difference of 13.3 cycles (p = 0.025) in favor of the pull-out technique. In all cases, repair failure occurred at the junction of the fibrocartilage with the suture. Arthroscopic repair with the pull-out technique showed greater biomechanical resistance to pronosupination movement in comparison to the anchor technique. Interestingly, the failure of arthroscopic repair of Atzei type II lesions occurs at the junction between the suture and the fibrocartilage.

Arthroscopic Repair of Triangular Fibrocartilage Complex Tear

Triangular fibrocartilage complex (TFCC) is an important structure for stability of distal radioulnar joint (DRUJ) and shock absorption of ulnocarpal joint. Recent studies on anatomy and biomechanics of TFCC have revealed that the deep fiber of distal radioulnar ligament plays a key role in stabilizing the DRUJ. Clinicians should evaluate the presence of the instability of DRUJ or ulnar impaction syndrome. If necessary, combined TFCC foveal repair and ulnar shortening osteotomy should be performed. This article introduces the authors’ preferred procedure of arthroscopic TFCC repair with satisfactory clinical outcomes.

Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair.

Background A pre-tied suture device has been utilized for all-arthroscopic peripheral triangular fibrocartilage complex (TFCC) repairs with promising early clinical results. Purpose The purpose of this study was to evaluate long-term functional outcomes of these repairs. Patients and Methods A retrospective review of patients undergoing arthroscopic TFCC repair was performed. Inclusion criteria were the Palmer type 1B TFCC tears diagnosed on arthroscopy and repaired using the all-arthroscopic pre-tied suture device. Patients with any evidence of concomitant wrist injury at the time of surgery, history of prior wrist surgery, or nonrepairable and nonperipheral TFCC tears were excluded. Postoperative complications, range of motion, grip strength, and outcome assessments were recorded for each patient. Results Eleven patients (mean age, 36 years; range, 20-64 years) satisfied our inclusion criteria and comprised the study cohort. The mean follow-up period was 7.0 years (range, 4.3-10.9 years). Mean range of motion of the wrist revealed flexion of 76 ± 11 degrees and extension of 73 ± 12 degrees. Mean grip strength was 98 ± 15% of the nonsurgical extremity. QuickDASH, modified Mayo, and patient-rated wrist evaluation (PRWE) average scores were 9 ± 8, 80 ± 6, and 12 ± 12, respectively. No surgical complications were observed and no patient required any further surgical intervention. Conclusions Our cohort of patients following all-arthroscopic pre-tied suture device repair of isolated Palmer type 1B TFCC tears demonstrated excellent clinical function at a mean follow-up of 7 years. These findings indicate that the pre-tied suture device is a reliable, safe, effective, and most importantly, durable treatment option for repair of peripheral TFCC tears. Level of Evidence This is a Level IV, therapeutic study.

RETRACTED ARTICLE: Prognostic factors for the outcome of arthroscopic capsular repair of peripheral triangular fibrocartilage complex tears

Little information is available about prognostic factors of arthroscopic capsular repair for peripheral triangular fibrocartilage complex (TFCC) lesions. The purpose of this study was to analyze factors that affect the treatment outcomes of arthroscopic capsular repair for peripheral TFCC tears. This study retrospectively enrolled 60 patients who were treated with arthroscopic outside-in capsular repair for peripheral TFCC tears. Functional survey, including pain numeric rating scale (NRS) on an ulnar provocation test, distal radio-ulnar joint (DRUJ) stress test, Disability of the Arm, Shoulder, and Hand (DASH) score, and satisfaction with treatment, was conducted at 12-month follow-up. Patients who were enthusiastic or satisfied comprised the satisfied group, and those who were noncommittal or disappointed the dissatisfied group. Demographic, clinical, and arthroscopic findings were compared between the satisfied and dissatisfied groups. The mean pain NRS and DASH scores exhibited significant clinical improvement at the 12-month follow-up. Out of the total participants, 46 were satisfied and 14 were dissatisfied about the treatment, with significantly more female subjects in the dissatisfied group than in the satisfied one. The patients in the satisfied group had a shorter duration of symptoms, were more likely to have trauma history, and exhibited positive DRUJ stress test results compared to the dissatisfied group. There were no significant group differences in age, hand dominance, work level, and the extent of ulnar plus variance. Multivariable analysis revealed that female gender, a longer duration of symptoms, or negative DRUJ stress test results were associated with an increased disability after arthroscopic TFCC repair. Female gender, a longer duration of symptom, and a negative DRUJ stress test are associated with a higher likelihood of treatment failure after arthroscopic outside-in capsular repair of peripheral TFCC tears.

Proximity of the Triangular Fibrocartilage Complex to Key Surrounding Structures and Safety Assessment of an Arthroscopic Repair Technique: A Cadaveric Study

To quantify the distance of the dorsal ulnar sensory branch, floor of the extensor carpi ulnaris (ECU) subsheath, and ulnar neurovascular bundles from the triangular fibrocartilage complex (TFCC), and secondarily to assess the safety of an all-inside arthroscopic repair of the TFCC with a commonly used meniscal repair device with respect to the aforementioned structures. A custom K-wire with 1-mm gradation was used to determine the distance of at-risk structures from the periphery of the TFCC in 13 above-elbow human cadaver specimens. An all-inside repair of the TFCC at the location of a Palmer 1B tear was then performed using a commonly employed meniscal repair device. The distance from the deployed devices to the structure in closest proximity was then measured using digital calipers. The mean distance from the deployed device to the nearest structure of concern for iatrogenic injury was 9.4mm (range, 5-15mm). The closest structure to iatrogenic injury was usually, but not always, the dorsal ulnar sensory nerve in 9 of 13 wrists (69.2%) at 9.3mm (range, 5-15mm); on 3 occasions it was instead the ulnar nerve (23.1%) at 9.5mm (range, 9-10mm), and on 1 occasion 6mm from the flexor digitorum profundus to the little finger (7.7%). Forearm rotation had no significant effect on measured distances (ulnar nerve: P= .98; dorsal sensory: P= .89; ECU: P= .90). The largest influence of forearm rotation was a 0.4-mm difference between pronation and supination with respect to the distance of the TFCC periphery on the ECU subsheath. An all-inside arthroscopic TFCC repair using a commonly used meniscal repair device appears safe with respect to nearby neurovascular structures and tendons under typical arthroscopic conditions. An all-inside arthroscopic TFCC repair using a commonly employed meniscal repair device appears safe in terms of proximity to important structures although further clinical investigation is warranted.

Arthroscopic Trans-osseous Suture of Peripheral Triangular Fibrocartilage Complex Tear.

The importance of foveal repair of the triangular fibrocartilage complex (TFCC) on stability of the distal radioulnar joint (DRUJ) has been emphasized with increasing knowledge of the anatomy and biomechanics of the TFCC and DRUJ. Although both open and arthroscopic techniques have been described for improving DRUJ stability, there has been a marked evolution of arthroscopic TFCC repair technique with successful clinical outcome. Recently, an arthroscopic trans-osseous technique has been described to repair foveal tears of the TFCC. The advantage of the technique is that it allows for anatomical repair of both the superficial and deep layers. This article describes the details of this novel technique.

Conservative Treatment Is Sufficient for Acute Distal Radioulnar Joint Instability With Distal Radius Fracture

Treatments for acute distal radioulnar joint (DRUJ) instability with distal radius fracture vary from conservative to operative treatment, although it seems to be no consensus regarding which treatment is optimal. This prospective randomized study was designed to compare the clinical outcomes for operative and conservative treatment of acute DRUJ instability with distal radius fracture, according to the presence or absence and type of ulnar styloid process fracture and the degree of its displacement. Between July 2008 and February 2013, we enrolled 157 patients who exhibited an unstable DRUJ during intraoperative manual stress testing (via the ballottement test) after fixation of the distal radius. Patients were classified according to the type of the ulnar styloid process fracture, using preoperative wrist radiography, and each group was divided into subgroups, according to their treatment method. We then compared the clinical outcomes between the conservative and operative treatments, using their range of motion; Disabilities of the Arm, Shoulder, and Hand score; modified Mayo wrist score; and grip strength. At 3 months after surgery, among patients without ulnar styloid process fracture, the flexion-extension range was 79 ± 15° after supination sugar-tong splinting (group A-1), 91 ± 14° after DRUJ transfixation (group A-2), and 89 ± 10° after arthroscopic triangular fibrocartilage complex repair (group A-3); the operative treatments provided greater joint motion ranges than conservative treatment. The groups with ulnar styloid process fractures at the tip (group B) or base (group C) also exhibited better clinical outcomes after the operative treatments, compared with after the conservative treatment. However, at the final follow-up, groups A-1, A-2, and A-3 exhibited similar flexion-extension ranges (122 ± 25°, 119° ± 18°, and 120° ± 16°, respectively) and modified Mayo wrist scores (87 ± 7, 89 ± 8, and 85 ± 9). Thus, the conservative and operative treatments provided similar long-term outcomes, and similar results were observed for patients with ulnar styloid process fracture at the tip or base. The average splint application period for patients who underwent conservative treatment was 6.6 weeks (range, 4-9 weeks). In our practice, conservative treatment (supination sugar-tong splinting) and surgical treatments provided similar long-term outcomes for acute DRUJ instability with distal radius fracture.

Simple debridement has little useful value on the clinical course of recalcitrant ulnar wrist pain

The purpose of this study was to evaluate treatment results following arthroscopic triangular fibrocartilage complex (TFCC) debridement for recalcitrant ulnar wrist pain. According to the treatment algorithm, 66 patients (36 men and 30 women with a mean age of 38.1 years (15 to 67)) with recalcitrant ulnar wrist pain were allocated to undergo ulnar shortening osteotomy (USO; n = 24), arthroscopic TFCC repair (n = 15), arthroscopic TFCC debridement (n = 14) or prolonged conservative treatment (n = 13). The mean follow-up was 36.0 months (15 to 54). Significant differences in Hand20 score at 18 months were evident between the USO group and TFCC debridement group (p = 0.003), and between the TFCC repair group and TFCC debridement group (p = 0.029). Within-group comparisons showed that Hand20 score at five months or later and pain score at two months or later were significantly decreased in the USO/TFCC repair groups. In contrast, scores in the TFCC debridement/conservative groups did not decrease significantly. Grip strength at 18 months was significantly improved in the USO/TFCC repair groups, but not in the TFCC debridement/conservative groups. TFCC debridement shows little benefit on the clinical course of recalcitrant ulnar wrist pain even after excluding patients with ulnocarpal abutment or TFCC detachment from the fovea from the indications for arthroscopic TFCC debridement.

Revision Wrist Arthroscopy After Failed Primary Arthroscopic Treatment (SS-47)

<h3>Introduction</h3> Arthroscopic treatment of ulnar-sided wrist pain is becoming increasingly prevalent; however, little is known about cases in which primary treatment fails to relieve symptoms. The purpose of this study was to identify common reasons for revision wrist arthroscopy. <h3>Methods</h3> Between March 1997 and July 2010, 23 non-staging revision wrist arthroscopies were performed by the senior author. Twelve patients with intercurrent relief of symptoms or traumatic injury were excluded. One was excluded based on concomitant neuropathy. The remaining eleven patients (5 male and 6 female; mean age 24 years) had symptoms that did not improve with primary arthroscopic treatment, requiring revision wrist arthroscopy at a mean of 14.7 months (4-38 months). Ten patients were originally diagnosed with triangular fibrocartilage complex (TFCC) tears; the remaining patient had no identifiable lesions. Data were collected through retrospective review of intraoperative and clinical findings. <h3>Results</h3> All 11 patients required revision procedures because of persistent wrist pain. In 5 of the 11 patients (45%), distal radial ulnar joint (DRUJ) instability was the major cause for revision. Revisions for all 5 patients revealed TFCC peripheral damage requiring repair (1 revision of an unstable repair, 4 previously treated with only debridement). One patient was lost to follow-up, but all 4 remaining (100%) had complete resolution of pain, regaining normal range of motion (ROM) with DRUJ stability. The chief cause for revision in 5 of the 11 patients (45%) was failure to treat ulnar abutment syndrome (UAS). Initially, 1 of these 5 patients presented with chronic ulnocarpal wrist pain, while 4 of the 5 had presented with pain following injury. These 4 were treated purely as traumatic TFCC tears in prior procedures, with no measures taken to correct ulnar positive variance. Notably, 2 of these patients showed ulnar neutral variance on plain films, but intraoperatively demonstrated lunate cartilaginous damage indicative of dynamic ulnar positive variance. All 5 patients were treated with an arthroscopic wafer ulnar shortening, regaining normal ROM in all cases (100%) and complete relief of pain in 4 (80%). One patient (11%) required revision for a previously undiagnosed scapholunate interosseous ligament (SLIL) tear. This was initially a traumatic case, presenting with ulnocarpal wrist pain that persisted after primary arthroscopic TFCC repair. Revision arthroscopy revealed a Grade-II SLIL tear, which was treated with radiofrequency capsular shrinkage, scaphoid reduction, and percutaneous scaphocapitate pinning. Overall, at an average of 7.3 months follow-up (3-35 months), 10 of 11 wrists (91%) exhibited full ROM, with 8 of the 10 also reporting complete resolution of ulnocarpal wrist pain, as seen in Table 1. <h3>Conclusion</h3> Careful attention to a number of key factors may reduce the incidence of revision arthroscopy. DRUJ instability can be better assessed with arthroscopic-assisted shuck testing, both before and after TFCC repair is performed. A thorough evaluation for UAS—both static and dynamic—in traumatic TFCC tears may reduce the recurrence of pain and revision procedures to address the underlying pathology. Finally, treatment outcomes for traumatic ulnocarpal wrist pain may be improved by identifying concurrent radial-side intercarpal ligament injuries.

All-Arthroscopic Repair of Peripheral Triangular Fibrocartilage Complex Tears

Injuries to the triangular fibrocartilage complex (TFCC) are common after a fall onto an outstretched hand. Tears of the periphery of the TFCC (Palmer 1B) refractory to conservative management should be treated with surgical repair. The FasT-Fix (Smith and Nephew, Andover, MA) enables an all-inside arthroscopic TFCC repair and has been shown to be biomechanically stronger than other techniques. A recent retrospective review identified the initial clinical outcomes of this technique. The average follow-up was 16.1 months (range, 6-24). The mean supination was 81° (±13.1°), and the mean grip strength was 66% (±13.8%) of the nonoperative extremity by, on average, 3 months postoperatively. All other range of motion was full. The mean Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation score was 10.2 (±11.4) and 18.8 (±13.5), respectively. The mean time to return to full activity was 5.2 months. There were no surgical complications of the procedure. Arthroscopic TFCC repair using the all-inside FasT-Fix results in excellent objective and subjective outcomes. Benefits of this technique are the ease of use, fewer complications, and the strength of repair allowing for less postoperative immobilization and earlier recovery when compared with other techniques.

Outside-in Repair of Peripheral Triangular Fibrocartilage Complex Tears

Tears of the triangular fibrocartilage complex (TFCC) are common sources of ulnar-sided wrist pain within athletics that frequently go unrecognized or are diagnosed simply as wrist “sprains.” TFCC injuries vary along a wide spectrum based on acuity and location. Although degenerative tears are often associated with ulnar impaction and are usually best treated with debridement or joint leveling procedures, acute tears of the peripheral portion of the TFCC have been shown to have adequate blood supply and the potential to heal, analogous to the meniscus of the knee. Multiple open and arthroscopic TFCC repair techniques have been described with good results. The outside-in technique described here is most useful in cases of acute tears at the ulnar periphery of the TFCC (type IB), with isolated ulnar-sided wrist pain and no signs or symptoms of distal radioulnar joint instability.

Triangular Fibrocartilage Complex Tears Associated With Symptomatic Ulnar Styloid Nonunions

Tear of the triangular fibrocartilage complex (TFCC) and nonunion of the ulnar styloid are common lesions resulting from upper extremity injuries such as distal radius fractures. Whereas ulnar styloid fractures are a common feature of the distal radius fracture pattern, symptomatic nonunions of the ulnar styloid are found in a minority of these injuries. The purposes of this study were to confirm the association of symptomatic ulnar styloid nonunions and TFCC tears, and to report intra-articular findings and clinical outcomes for the concurrent arthroscopic management of TFCC tears and open excision of ulnar styloid nonunions in a consecutive series of patients. We retrospectively reviewed the medical records of 8 consecutive patients who underwent open excision of an ipsilateral ulnar styloid nonunion fragment and concurrent diagnostic arthroscopy. The diagnosis of TFCC tear was made by magnetic resonance imaging preoperatively in only 5 of 8 patients. We assessed outcomes with the Disabilities of the Arm, Shoulder, and Hand questionnaire and the visual analog scale. Arthroscopic findings demonstrated full-thickness chondral injury on the dorsum of the triquetrum with a tear of the dorsal radiolunotriquetral ligament and avulsion of the ulnar margin of the TFCC from the extensor carpi ulnaris subsheath. The clinical outcome scores showed statistically significant improvement (p<.05) from the preoperative baseline, with a mean Disabilities of the Arm, Shoulder, and Hand score of 3.69 (SD, 9.68) and a mean visual analog scale pain score of 1.0 (SD, 0.83) postoperatively. Symptomatic ulnar styloid nonunions can be associated with TFCC tears, and diagnostic arthroscopy should be considered in all patients who are candidates for open excision of an ulnar styloid nonunion. Concurrent arthroscopic TFCC repair and open excision of the ulnar styloid fragment is an effective surgical approach for this combined injury pattern.