What Have We Learned in the Wrist Joint of Distal Radius Fracture through Wrist Arthroscopy?

Abstract

Background Wrist arthroscopy is an efficient tool for the surgical treatment of distal radius fracture (DRF). It could show us the various conditions of the radiocarpal joint, its effectiveness seems to overwhelm that of fluoroscopy.

Methods Since July 2005, we have performed wrist arthroscopy and plate presetting arthroscopic reduction technique (PART) for 141 extra-articular and 559 intra-articular DRFs and investigated various kinds of intra-articular conditions and advantages of wrist arthroscopy.

Results The pathological conditions clarified and the advantages of PART in the surgical treatment of DRF are: (1) accurate reduction of intra-articular fragments is possible compared with fluoroscopic reduction, (2) intra-articular fragments (free body) undetected with radiograph and CT can be recognized, (3) screw protrusion into joint surface can be monitored, (4) intra-articular soft tissue injury associated with fracture can be evaluated and treated, and (5) debridement of joint hematoma can be performed. Severe complications such as tendon rupture, major neurovascular injury or compartment syndrome from arthroscopy were never encountered.

Conclusions The volar locking plate fixation and simultaneous arthroscopic intervention is problematic because vertical traction must be applied and released during surgery. PART can overcome these difficulties and achieved good clinical results.

Keywords

wrist - arthroscopy - distal radius fracture - intra-articular fracture - articular step-off

Publication History

Received: 14 May 2024

Accepted: 25 June 2024

Article published online:
25 July 2024

• References

• 1 Doi K, Hattori Y, Otsuka K, Abe Y, Yamamoto H. Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation. J Bone Joint Surg Am 1999; 81 (08) 1093-1110
• 2 Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996; 78 (03) 357-365
• 3 Ruch DS, Vallee J, Poehling GG, Smith BP, Kuzma GR. Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures. Arthroscopy 2004; 20 (03) 225-230
• 4 Abe Y, Tsubone T, Tominaga Y. Plate presetting arthroscopic reduction technique for the distal radius fractures. Tech Hand Up Extrem Surg 2008; 12 (03) 136-143
• 5 Abe Y, Yoshida K, Tominaga Y. Less invasive surgery with wrist arthroscopy for distal radius fracture. J Orthop Sci 2013; 18 (03) 398-404
• 6 Abe Y. Plate presetting and arthroscopic reduction technique (PART) for treatment of distal radius fractures. Handchir Mikrochir Plast Chir 2014; 46 (05) 278-285
• 7 Abe Y, Fujii K. Arthroscopic-assisted reduction of intra-articular distal radius fracture. Hand Clin 2017; 33 (04) 659-668
• 8 Abe Y, Tominaga Y, Yoshida K. Various patterns of traumatic triangular fibrocartilage complex tear. Hand Surg 2012; 17 (02) 191-198
• 9 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
• 10 Abe Y, Doi K, Hattori Y, Ikeda K, Dhawan V. A benefit of the volar approach for wrist arthroscopy. Arthroscopy 2003; 19 (04) 440-445
• 11 Abe Y, Doi K, Hattori Y, Ikeda K, Dhawan V. Arthroscopic assessment of the volar region of the scapholunate interosseous ligament through a volar portal. J Hand Surg Am 2003; 28 (01) 69-73
• 12 Del Piñal F. Technical tips for (dry) arthroscopic reduction and internal fixation of distal radius fractures. J Hand Surg Am 2011; 36 (10) 1694-1705