A Comprehensive Observation of the Morphology and the Neurovascular Pattern of the Triangular Fibrocartilage Complex [TFCC] of the Wrist Joint

Objectives: This study aims to provide a comprehensive understanding of the unique morphological dimensions and neurovascular pattern of the triangular fibrocartilage complex (TFCC) of the wrist joint, using innovative techniques such as digital Vernier calliper, auramine chloride (Palmgren’s method) and immunohistochemistry. Methods: Samples were collected from ۲۰ formalin-embalmed human cadavers. The morphometric parameters were measured. After gross examination, tissues were placed in ۱۰% neutral buffered formalin for fixation. Paraffin-embedded blocks were prepared, and tissue sections were taken at ۵-۷ microns thickness. The slides were subjected to Palmgren’s and immunohistochemistry staining following a standardised protocol. Results: The morphometric parameters of the articular disc (AD) and neurovascular pattern of the seven components of TFCC were assessed. There was no significant difference in the morphometric parameters between either sides of the limb. The AD had minimal nerve fibre innervation. Periphery of the complex, which consisted of different ligaments, showed higher nerve density comparatively. The distribution of nerve fibres predominated in the proximal portion compared to distal areas of TFCC. The vascular pattern observed in various components showed fewer blood vessels in the AD than in the periphery. Higher vascularity was observed in the proximal portion of the TFCC complex. Conclusion: The insights gained from this study, particularly the understanding of the innervation and distribution of nerve fibres of TFCC, can significantly enhance the effectiveness of selective denervation procedures during wrist arthroscopy. Moreover, the knowledge about the vascularity of TFCC is a crucial factor that can influence the end outcomes of wrist surgeries.         Level of evidence: IV

Keywords:

neurovascular pattern , Triangular fibrocartilage complex , Wrist joint