The Outcome of Distal Radius Fractures with Concomitant Injuries Is Similar to those of Isolated Distal Radius Fractures Provided that an Arthroscopically Supported Treatment Is Performed

Abstract

Background: Concomitant injuries of distal radius fractures (DRF) can have a fatal impact on the patients' outcome. However, wrist arthroscopy is a costly and complex procedure. It remains elusive whether patients benefit from an additional arthroscopy.

Methods: Patients with a DRF who were treated arthroscopically were enrolled. Fifty-six wrists were evaluated regarding their function by self-assessment with the Munich Wrist Questionnaire (MWQ). Thirty-nine patients were examined for postoperative strength and motion. Concomitant injuries were detected.

Results: A total of 75% of the DRF were type C injuries (AO classification). Twenty-four cases (43%) were triangular fibrocartilaginous complex (TFCC) lesion, eight cases (14%) of scapholunate ligament (SL) injuries and seven cases (12%) were a combination of TFCC and SL ligament lesion. No difference in function could be detected between DRF with surgically addressed concomitant lesions and isolated DRF. Dorsalextension, palmarflexion and grip strength were significantly reduced in patients with DRF and concomitant injuries compared to the healthy wrist. However, patients with DRF and arthroscopically treated concomitant injuries had similar results to those suffering only from an isolated DRF.

Conclusion: The increased occurrence of concomitant injuries is to be expected in intraarticular DRF. Patients with concomitant injuries benefit from an arthroscopically assisted fracture treatment and show similar results compared to isolated DRF.

Keywords: TFCC lesion; distal radius fracture; scapholunate ligament rupture; wrist arthroscopy.

Figure 1

Construction arthroscopy.

Figure 2

Arthroscopy. (A) Arthroscopically assisted distal radius fracture. The fracture has been set anatomically; however, the patient also has a radial discus rupture type 1D according to the Palmer classification, which is unstable, (B) and has to be repaired; (C) a central discus tear type 1A according to the Palmer classification; (D) discus after a stable resection of the ruptured part.

Figure 3

Study collective. In the period between June 2012 and February 2015, 71 wrists of 72 patients were operated on by arthroscopically assisted fracture treatment. Of these, 56 wrists from 55 patients were included in our study. In addition, 39 patients were examined clinically.

Figure 4

Age distribution and function. (A) The female collective was significantly older than the male patients; (B) no difference in function of the wrist could be detected according to the self-assessment score (MWQ) between fractures with arthroscopically treated concomitant injuries and isolated fractures of the distal radius (86% ± 2% vs. 86% ± 3%, mean ± SEM).

Figure 5

Grip strength. (A) Statistically significant reduced grip strength in the injured hand compared to the healthy wrist; (B) patients suffering from distal radius fractures with concomitant injuries had a significantly reduced grip strength compared to the healthy wrist; (C) patients suffering from distal radius fractures and SL ligament tears had a significantly reduced grip strength compared to the control; (D) no difference between patients suffering from isolated distal radius fractures and those with distal radius fractures and arthroscopically treated concomitant lesions.

Figure 6

Dorsalextension. (A) Significantly reduced dorsalextension in the injured wrist (fracture of the distal radius with and without concomitant injury) compared to the healthy wrist; (B) significantly reduced dorsalextension in fractures with concomitant injuries compared to the healthy wrist; (C) significantly reduced dorsalextension in fractures with concomitant triangular fibrocartilaginous complex (TFCC) lesions compared to the healthy wrist; (D) no difference between patients suffering from isolated distal radius fractures and those with distal radius fractures and arthroscopically treated concomitant lesions.

Figure 7

Palmarflexion. (A) Significantly reduced palmarflexion in the injured wrist (fracture of the distal radius with and without concomitant injuries) compared to the healthy wrist; (B) significantly reduced palmarflexion in fractures with concomitant injuries compared to the healthy wrist; (C) significantly reduced palmarflexion in fractures with concomitant TFCC lesions compared to the healthy wrist; (D) no difference between patients suffering from isolated distal radius fractures and those with distal radius fractures and arthroscopically treated concomitant lesions.