The application of indirect reduction techniques in the distal radius: the role of adjuvant arthroscopy

Abstract

Purpose: The re-establishment of distal radius alignment and articular congruency after fracture has been approached by a variety of methods in order to limit injury sequelae such as degenerative osteoarthritis. Although arthroscopy has been beneficial for other articular fractures, it is unclear to what degree arthroscopy should be used for treatment of distal radius articular fractures, especially when avoiding full-open procedures that can promote arthrofibrosis. The purpose of this study was to determine the utility of adjuvant wrist arthroscopy and whether a diagnostic benefit is observed during treatment.

Type of study: A modified protocol for treatment of intra-articular distal radius fractures was developed in a crossover trial fashion for the purposes of this study.

Materials and methods: Thirty-three consecutive subjects treated over a 2-year period were included for study. Fractures were classified according to Melone, treated by indirect reduction techniques under fluoroscopic visualization, stabilized by static external fixation, and supplemented with percutaneous pins or bone graft as needed. The adequacy of reduction under fluoroscopic visualization was assessed by arthroscopic visualization after this initial treatment.

Results: 14.3% of type I fractures, 37.5% of type II fractures, 33.3% of type III fractures, and 71.4% of type IV fractures were modified due to arthroscopic visualization after initial treatment by indirect reduction techniques. No subject required a full-open procedure for subsequent reduction.

Conclusions: Based on these data, surgical treatment of intra-articular distal radius fractures solely under fluoroscopic visualization appears inadequate to re-establish articular congruency. Adjuvant wrist arthroscopy provides a diagnostic benefit in determining whether distal radius articular fracture reduction is adequate and may also translate to direct improvement in patient satisfaction and outcome by limiting injury sequelae. When considering indirect reduction techniques for distal radius articular injury, we recommend routine arthroscopic evaluation to verify and assist in re-establishment of articular congruency.