Characteristics of patients with distal radius fracture requiring arthroscopic foveal repair after bone union

Background: Distal radius fractures (DRFs) are often accompanied by triangular fibrocartilage complex (TFCC) tears, which may result in distal radioulnar joint (DRUJ) instability and ulnar-sided wrist pain.However, the necessity and timing of TFCC repair remain controversial, as many tears are asymptomatic and may not require surgical intervention.This study aimed to identify the clinical characteristics of patients who required TFCC repair following DRFs and evaluate outcomes.Methods: This study retrospectively reviewed 354 patients (361 wrists) treated surgically for DRFs between March 2021 and December 2024.Ten patients experienced persistent ulnar-sided pain and DRUJ instability following fracture union and were considered for TFCC repair (Group 1).The remaining patients without TFCC-related symptoms were designated as Group 2. Demographic factors, initial fracture classification, and concomitant ulnar fracture were compared.In Group 1, radiologic parameters were measured on radiographs obtained immediately following the initial DRF fixation to verify reduction quality.Clinical outcomes following TFCC repair were assessed using the visual analog scale (VAS) and disabilities of the arm, shoulder, and hand (DASH) score.Results: Group 1 patients were significantly younger (median, 39.0 vs. 65.0 years), taller (166.5 vs. 159.0cm), and more often male than Group 2 patients.High-energy or sports-related trauma mechanisms were common.Radiographs taken after initial DRF fixation revealed values within normal ranges, confirming anatomical reduction.Of the 10 patients, 7 underwent delayed transosseous TFCC repair at a mean of 11.1 months; 6 were arthroscopic and 1 open.The VAS score improved from 5.7 to 2.5 and the DASH score from 46.9 to 17.5.Two patients experienced arthritis, and one had a suspected retear.Conclusion: TFCC repair is required only in a small but clinically important subset of patients, typically younger and active, who have persistent symptoms.Delayed repair yields favorable outcomes, and radiographs confirmed adequate initial fixation.Careful patient selection remains essential.