Contribution of arthroscopy to the treatment of intraarticular fracture of the distal radius: Retrospective study of 40 cases

Abstract

Our study aimed to compare the anatomical result after treatment of intraarticular distal radius fracture with locking volar plates with and without arthroscopy. This was a retrospective, single-center study of intraarticular fractures. A volar locked plate was used for fracture fixation in all patients. Twenty patients were operated on with fluoroscopy only ("plate" group) and 20 operated using arthroscopy assistance ("arthroscopy" group). All patients underwent a CT scan before surgery and at 3 months postoperative. The main outcome measure was the residual intraarticular step-off (measured in millimeters). Other studied outcomes were the residual gap between fragments and extra-articular reduction. The two groups were similar preoperatively in all aspects except the size of the gap between fragments. The residual step-off was significantly less in the arthroscopy group: 1.9mm (Q₁ 1.7; Q₃ 2.25) for plate versus 0.8mm (Q₁ 0.7; Q₃ 1.5) for arthroscopy (P=0.001). The change from the preoperative to the postoperative measurement was significantly greater in the arthroscopy group: 0.1 mm (Q₁ -0.5; Q₃ 0.8) for plate and -1mm (Q₁ -1.9; Q₃ -0.6) for arthroscopy (P=0.0002). The residual gap was similar between both groups: 2.4mm (Q₁ 1.9; Q₃ 3.5) for plate vs. 2.3mm (Q₁ 1.1; Q₃ 2.8) for arthroscopy (P=0.37). The change in gap was not significantly different between the two groups: -0.9mm (Q₁ -1.8; Q₃ -0.1) for plate vs. -2.9mm (Q₁ -4.4; Q₃ -1.7) for arthroscopy (P=0.32). There was no difference in the extra-articular reduction. Damage was found to the scapholunate ligament in 30% and the TFCC in 30% of arthroscopy cases. Arthroscopy improves intraarticular reduction without altering extra-articular reduction in patients with intraarticular fractures of the distal radius, and it allows for assessment and treatment of any injuries discovered. We must now follow these patients over the long-term to assess the clinical benefit.

Level of evidence: 3.

Keywords: Arthroscopie; Arthroscopy; Distal radius fracture; Fracture du radius distal; Intraarticular reduction; Plaque palmaire verrouillée; Réduction intra-articulaire; Volar locking plate.