RSS-Feed abonnieren
DOI: 10.1055/s-0040-1719039
Comparing Outcomes between Arthroscopic-Assisted Reduction and Fluoroscopic Reduction in AO Type C Distal Radius Fracture Treatment
![](https://www.thieme-connect.de/media/jws/202102/lookinside/thumbnails/10-1055-s-0040-1719039_2000107cra-1.jpg)
Abstract
Background Distal radius fracture is one of the most common injuries. Poor functional result with restricted wrist motion can be developed when there is intra-articular fibrous tissue development arising from articular step-off and gapping.
Objectives The aim of this study is to compare the functional and radiological outcome between arthroscopic-assisted reduction and fluoroscopic reduction in treating unstable intra-articular distal radius fracture.
Methods We retrospectively analyzed 12 patients with intraarticular AO type C distal radius fracture treated with arthroscopic-assisted fracture reduction and internal fixation and compared them with another group of 12 patients in which fracture reduction is assessed by fluoroscopy alone (15 males and 9 females, mean age 57.3, range 27–73). The two cohorts were analyzed for differences in radiological parameters including articular stepping and gapping, palmar tilt, radial inclination, ulnar variance as well as functional outcome in range of motion, grip strength, modified mayo wrist score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score at an average of 12.5 months (range 5–26) after surgery.
Results Arthroscopic-assisted fracture reduction group has statistically better restoration of articular stepping and gapping, volar tilt and ulnar variance. Range of motion, grip strength, modified mayo wrist score and Quick DASH score also had statistically significant improvement in arthroscopic group.
Conclusion Our study showed arthroscopic-assisted technique can precisely restore radiological parameters in highly comminuted distal radius fracture with good functional outcome. Also, associated intra-articular soft tissue injury can be detected and treated simultaneously.
Level of Evidence This is a level III, retrospective cohort study.
Keywords
distal radius fracture - wrist arthroscopy - arthroscopic assisted reduction - concomitant injuriesEthical Approval
This research project is approved and registered under Joint CUHK-NTEC Clinical Research Ethics Committee, with the reference number of CREC 2020.182.
Authors' Contributions
The patients were recruited and treated in Alice Ho Miu Ling Nethersole Hospital. S.C.J.J.K. researched literature conceived the study, led to protocol development, gaining ethical approval, and manuscript writing. S.C.J.J.K. and K.Y.A.L. conducted patient assessment. W.W.C. performed data analysis. All authors reviewed and edited the manuscript and approved the final version of the manuscript.
Publikationsverlauf
Eingereicht: 23. Juli 2020
Angenommen: 24. August 2020
Artikel online veröffentlicht:
04. November 2020
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Ruch DS, Weiland AJ, Wolfe SW, Geissler WB, Cohen MS, Jupiter JB. Current concepts in the treatment of distal radial fractures. Instr Course Lect 2004; 53: 389-401
- 2 Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 1986; 68 (05) 647-659
- 3 Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am 1994; 19 (02) 325-340
- 4 Gabl M, Arora R, Klauser AS, Schmidle G. Characteristics of secondary arthrofibrosis after intra-articular distal radius fracture. Arch Orthop Trauma Surg 2016; 136 (08) 1181-1188
- 5 Edwards II CC, Haraszti CJ, McGillivary GR, Gutow AP. Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction. J Hand Surg Am 2001; 26 (06) 1036-1041
- 6 Cooney III WP, Linscheid RL, Dobyns JH. External pin fixation for unstable Colles' fractures. J Bone Joint Surg Am 1979; 61 (6A): 840-845
- 7 Lafontaine M, Delince P, Hardy D, Simons M. Instability of fractures of the lower end of the radius: apropos of a series of 167 cases. Acta Orthop Belg 1989; 55 (02) 203-216
- 8 Walenkamp MM, Vos LM, Strackee SD, Goslings JC, Schep NW. The unstable distal radius fracture-how do we define it? A systematic review. J Wrist Surg 2015; 4 (04) 307-316
- 9 Boyer MI, Korcek KJ, Gelberman RH, Gilula LA, Ditsios K, Evanoff BA. Anatomic tilt x-rays of the distal radius: an ex vivo analysis of surgical fixation. J Hand Surg Am 2004; 29 (01) 116-122
- 10 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
- 11 Catalano III LW, Barron OA, Glickel SZ. Assessment of articular displacement of distal radius fractures. Clin Orthop Relat Res 2004; (423) 79-84
- 12 Lutsky K, Boyer MI, Steffen JA, Goldfarb CA. Arthroscopic assessment of intra-articular distal radius fractures after open reduction and internal fixation from a volar approach. J Hand Surg Am 2008; 33 (04) 476-484
- 13 Smeraglia F, Del Buono A, Maffulli N. Wrist arthroscopy in the management of articular distal radius fractures. Br Med Bull 2016; 119 (01) 157-165
- 14 Yamazaki H, Uchiyama S, Komatsu M. et al. Arthroscopic assistance does not improve the functional or radiographic outcome of unstable intra-articular distal radial fractures treated with a volar locking plate: a randomised controlled trial. Bone Joint J 2015; 97-B (07) 957-962
- 15 Abe Y, Yoshida K, Tominaga Y. Less invasive surgery with wrist arthroscopy for distal radius fracture. J Orthop Sci 2013; 18 (03) 398-404
- 16 Varitimidis SE, Basdekis GK, Dailiana ZH, Hantes ME, Bargiotas K, Malizos K. Treatment of intra-articular fractures of the distal radius: fluoroscopic or arthroscopic reduction?. J Bone Joint Surg Br 2008; 90 (06) 778-785
- 17 Forward DP, Lindau TR, Melsom DS. Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am 2007; 89 (11) 2334-2340
- 18 Geissler WB. Arthroscopically assisted reduction of intra-articular fractures of the distal radius. Hand Clin 1995; 11 (01) 19-29
- 19 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
- 20 Gunal I, Ozaksoy D, Altay T, Satoglu IS, Kazimoglu C, Sener M. Scapholunate dissociation associated with distal radius fractures. Eur J Orthop Surg Traumatol 2013; 23 (08) 877-881
- 21 Lee JS, Galla A, Shaw RL, Harris JH. Signs of acute carpal instability associated with distal radial fracture. Emerg Radiol 1995; 2 (02) 77-83
- 22 Lindau T, Arner M, Hagberg L. Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg [Br] 1997; 22 (05) 638-643
- 23 Mrkonjic A, Lindau T, Geijer M, Tägil M. Arthroscopically diagnosed scapholunate ligament injuries associated with distal radial fractures: a 13- to 15-year follow-up. J Hand Surg Am 2015; 40 (06) 1077-1082
- 24 Richards RS, Bennett JD, Roth JH, Milne Jr K. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am 1997; 22 (05) 772-776
- 25 Rosenthal DI, Schwartz M, Phillips WC, Jupiter J. Fracture of the radius with instability of the wrist. AJR Am J Roentgenol 1983; 141 (01) 113-116
- 26 Yoshida S, Yoshida K, Sakai K, Nakama K, Shiba N. Frequency of scapholunate ligament injuries associated with distal radius shearing fracture: correlation of fracture patterns and ligament tear. Hand Surg 2015; 20 (03) 440-446
- 27 Ruch DS, Yang CC, Smith BP. Results of acute arthroscopically repaired triangular fibrocartilage complex injuries associated with intra-articular distal radius fractures. Arthroscopy 2003; 19 (05) 511-516