Arthroscopically assisted osteosynthesis of distal intraarticular radius fractures

Summary

Objectives

Closed reduction and internal fixation of intraarticular distal radial fractures under direct vision of the articular surfaces. Concomitant control of additional carpal injuries and, if necessary, minimally invasive treatment.

Indications

Distal, intraarticular radial fractures, particularly of group B and C according to the AO fracture classification.

Fractures of group A with marked displacement with probable suspected additional carpal injuries, such as of scapholunar and lunotriquetral ligaments, triangular fibrocartilaginous complex.

Contraindications

Open fractures, polytrauma patients, comminuted intraarticular fractures.

Surgical Technique

Closed reduction of fracture. Arthrography of the wrist. Exact reduction of the fragments under arthroscopic control. Stabilization of fragments with the help of percutaneously introduced Kirschner wires and/or cannulated screws. If required, temporary arthrodesis of the scapholunar joint, or resection or reattachment of the articular disc.

Results

Thirty patients were treated with the described method, 23 of them showed additional injuries. Twenty-three patients who had surgery at least a year before were followed up at an average of 32.5 months (12 to 48) and were assessed according to the point score of Cooney. An excellent or good result was seen in 16 patients, a satisfactory result in 4 and a poor result in 3 patients. A transient paresthesia was noted in 3 patients, in 1 patient we observed an irritation of the extensor pollicis longus. Two patients required revision surgery: 1 shortening of the ulna, 1 plate fixation of the radius.