Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec;47(6):1971-1978.
doi: 10.1007/s00068-020-01354-9. Epub 2020 Mar 31.

Using mini-arthrotomy for dorsal plating to treat intraarticular distal radius fractures: can it improve radiological and clinical outcomes?

Annika Müller  1 , Christopher Child  1 , Florin Allemann  2 , Hans-Christoph Pape  2 , Philipe Breiding  3 , Florian Hess  4
Affiliations

Using mini-arthrotomy for dorsal plating to treat intraarticular distal radius fractures: can it improve radiological and clinical outcomes?

Annika Müller et al. Eur J Trauma Emerg Surg. 2021 Dec.

Abstract

Purpose: Using palmar plating to treat complex intraarticular distal radius fractures is standard of care. However, fracture fragments can also be managed using a dorsal approach with arthrotomy, which is useful when treating fractures involving the dorsal joint aspect. We compared radiological and clinical outcomes after dorsal plating with or without an intraoperative arthrotomy.

Methods: 31 of the 359 patients with a distal radius fracture had an AO Type 2R3 C3 fracture surgically treated using a dorsal approach (01/2015-10/2018). Fractures other than C3 were excluded from this analysis. Group 1 (n = 14) had no arthrotomy, Group 2 (n = 17) underwent intraoperative dorsal mini-arthrotomy. Clinical results were measured by range of motion (ROM), Patient-rated wrist evaluation (PRWE) and Disabilities of arm, shoulder and hand (DASH) scores. Radiological results were evaluated using the AO scoring system.

Results: ROM, DASH and PRWE did not differ significantly between groups. Joint surface restoration was insufficient in five patients in Group 1 (p = 0.05). A trend towards better radiological results, although not statistically significant, was noted in Group 2 (p = 0.06). Plate removal was performed in 12 patients due to limited ROM (6 patients in each group). One patient (Group 2) with chronic pain and step off in the joint line underwent corrective osteotomy.

Conclusions: We did not detect a difference in patient outcomes using the dorsal longitudinal mini-arthrotomy; however, it may prevent incongruent joint reconstruction since all cases occurred in Group 1. In the absence of intraoperative CT scan, longitudinal mini-arthrotomy may be used to enhance visualization and achieve joint surface reconstruction.

Keywords: AO type C fractures; Arthrotomy; Dorsal approach; Intraarticular distal radius fractures.

PubMed Disclaimer

References

    1. Mellstrand-Navarro C, Pettersson HJ, Tornqvist H, Ponzer S. The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study. Bone Joint J. 2014;96(7):963–9. https://doi.org/10.1302/0301-620X.96B7.33149 . - DOI - PubMed
    1. Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113–25. https://doi.org/10.1016/j.hcl.2012.02.001 . - DOI - PubMed - PMC
    1. Koo OT, Tan DM, Chong AK. Distal radius fractures: an epidemiological review. Orthop Surg. 2013;5(3):209–13. https://doi.org/10.1111/os.12045 . - DOI - PubMed - PMC
    1. Jakim I, Pieterse HS, Sweet MB. External fixation for intra-articular fractures of the distal radius. J Bone Joint Surg Br. 1991;73(2):302–6. - DOI
    1. Rogachefsky RA, Lipson SR, Applegate B, Ouellette EA, Savenor AM, McAuliffe JA. Treatment of severely comminuted intra-articular fractures of the distal end of the radius by open reduction and combined internal and external fixation. J Bone Joint Surg Am. 2001;83(4):509–19. https://doi.org/10.2106/00004623-200104000-00005 . - DOI - PubMed

LinkOut - more resources