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Arthroscopic debridement of the dorsal capsule in intraarticular distal radius fractures: does it provide superior outcomes?

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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Distal radius fractures (DRFs) are very common. One of the most significant complications after intraarticular DRF is arthrofibrosis with loss of wrist motion and pain. Wrist arthroscopy has become increasingly popular in the treatment of DRF with the advantage of good visualization of the joint surface and soft tissue injuries. In intraarticular DRFs injuries of the dorsal capsule are a characteristic finding which potentially cause loss of wrist motion. In this study, we investigated if arthroscopic debridement of dorsal capsule injuries at time of surgical fixation provides superior outcomes compared to the same treatment without debridement.

Materials and methods

Between 2013 and 2017, we included 42 patients who underwent arthroscopy-assisted palmar plating for intraarticular DRFs in a prospective randomized controlled study. In group A (intervention group), the dorsal capsule tears were debrided during primary surgery, while in group B these were left in place. Active range of motion (AROM), grip strength, subjective outcomes and radiographic results were assessed 3, 6 and 12 months after primary surgery. A subgroup analysis was performed for patient age, fracture severity and duration of immobilization.

Results

Arthroscopic debridement of the dorsal capsule improved AROM in patients over 60 years of age, more severe fractures (AO 23 C2/C3) and prolonged postoperative immobilization for more than two weeks, while it was not relevant for younger patients with simple fractures and short immobilization.

Conclusions

Debridement of the injured dorsal capsule in arthroscopic-assisted surgical treatment of intraarticular DRFs can improve surgical performance and optimize patient outcomes in a specific subgroup of patients.

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References

  1. Smeraglia F, Del Buono A, Maffulli N (2016) Wrist arthroscopy in the management of articular distal radius fractures. Br Med Bull 119(1):157–165. https://doi.org/10.1093/bmb/ldw032

    Article  PubMed  Google Scholar 

  2. Bentohami A, Bosma J, Akkersdijk GJ, van Dijkman B, Goslings JC, Schep NW (2014) Incidence and characteristics of distal radial fractures in an urban population in The Netherlands. Eur J Trauma Emerg Surg 40(3):357–361. https://doi.org/10.1007/s00068-014-0394-7

    Article  CAS  PubMed  Google Scholar 

  3. Pechlaner S, Gabl M, Lutz M, Krappinger D, Leixnering M, Krulis B, Ulmer H, Rudisch A, Arbeitsgruppe A (2007) Distal radius fractures–aetiology, treatment and outcome. Handchir Mikrochir Plast Chir 39(1):19–28. https://doi.org/10.1055/s-2007-964920

    Article  CAS  PubMed  Google Scholar 

  4. Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 68(5):647–659

    Article  CAS  Google Scholar 

  5. Fernandez DL, Geissler WB (1991) Treatment of displaced articular fractures of the radius. J Hand Surg Am 16(3):375–384. https://doi.org/10.1016/0363-5023(91)90001-r

    Article  CAS  PubMed  Google Scholar 

  6. Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL (1996) Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Jt Surg Am 78(3):357–365. https://doi.org/10.2106/00004623-199603000-00006

    Article  CAS  Google Scholar 

  7. Swart E, Tang P (2017) The effect of ligament injuries on outcomes of operatively treated distal radius fractures. Am J Orthop (Belle Mead NJ) 46(1):E41–E46

    Google Scholar 

  8. Gabl M, Arora R, Klauser AS, Schmidle G (2016) Characteristics of secondary arthrofibrosis after intra-articular distal radius fracture. Arch Orthop Trauma Surg 136(8):1181–1188. https://doi.org/10.1007/s00402-016-2490-0

    Article  CAS  PubMed  Google Scholar 

  9. Anderson DD, Bell AL, Gaffney MB, Imbriglia JE (1996) Contact stress distributions in malreduced intraarticular distal radius fractures. J Orthop Trauma 10(5):331–337. https://doi.org/10.1097/00005131-199607000-00007

    Article  CAS  PubMed  Google Scholar 

  10. Geissler WB, Fernandez DL (1991) Percutaneous and limited open reduction of the articular surface of the distal radius. J Orthop Trauma 5(3):255–264. https://doi.org/10.1097/00005131-199109000-00002

    Article  CAS  PubMed  Google Scholar 

  11. Trumble TE, Schmitt SR, Vedder NB (1994) Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am 19(2):325–340. https://doi.org/10.1016/0363-5023(94)90028-0

    Article  CAS  PubMed  Google Scholar 

  12. Trumble TE, Wagner W, Hanel DP, Vedder NB, Gilbert M (1998) Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation. J Hand Surg Am 23(3):381–394. https://doi.org/10.1016/S0363-5023(05)80455-1

    Article  CAS  PubMed  Google Scholar 

  13. Ono H, Katayama T, Furuta K, Suzuki D, Fujitani R, Akahane M (2012) Distal radial fracture arthroscopic intraarticular gap and step-off measurement after open reduction and internal fixation with a volar locked plate. J Orthop Sci 17(4):443–449. https://doi.org/10.1007/s00776-012-0226-8

    Article  PubMed  Google Scholar 

  14. Catalano LW 3rd, Cole RJ, Gelberman RH, Evanoff BA, Gilula LA, Borrelli J Jr (1997) Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation. J Bone Jt Surg Am 79(9):1290–1302. https://doi.org/10.2106/00004623-199709000-00003

    Article  Google Scholar 

  15. Goldfarb CA, Rudzki JR, Catalano LW, Hughes M, Borrelli J Jr (2006) Fifteen-year outcome of displaced intra-articular fractures of the distal radius. J Hand Surg Am 31(4):633–639. https://doi.org/10.1016/j.jhsa.2006.01.008

    Article  PubMed  Google Scholar 

  16. Geissler WB, Freeland AE (1999) Arthroscopic management of intra-articular distal radius fractures. Hand Clin 15(3):455–465 (viii)

    Article  CAS  Google Scholar 

  17. Lutsky K, Boyer MI, Steffen JA, Goldfarb CA (2008) Arthroscopic assessment of intra-articular distal radius fractures after open reduction and internal fixation from a volar approach. J Hand Surg Am 33(4):476–484. https://doi.org/10.1016/j.jhsa.2007.12.009

    Article  PubMed  Google Scholar 

  18. Edwards CC 2nd, Haraszti CJ, McGillivary GR, Gutow AP (2001) Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction. J Hand Surg Am 26(6):1036–1041. https://doi.org/10.1053/jhsu.2001.28760

    Article  PubMed  Google Scholar 

  19. Abe Y, Yoshida K, Tominaga Y (2013) Less invasive surgery with wrist arthroscopy for distal radius fracture. J Orthop Sci 18(3):398–404. https://doi.org/10.1007/s00776-013-0371-8

    Article  PubMed  Google Scholar 

  20. Auge WK 2nd, Velazquez PA (2000) The application of indirect reduction techniques in the distal radius: the role of adjuvant arthroscopy. Arthroscopy 16(8):830–835. https://doi.org/10.1053/jars.2000.17717

    Article  PubMed  Google Scholar 

  21. Geissler WB (2005) Intra-articular distal radius fractures: the role of arthroscopy? Hand Clin 21(3):407–416. https://doi.org/10.1016/j.hcl.2005.02.009

    Article  PubMed  Google Scholar 

  22. Varitimidis SE, Basdekis GK, Dailiana ZH, Hantes ME, Bargiotas K, Malizos K (2008) Treatment of intra-articular fractures of the distal radius: fluoroscopic or arthroscopic reduction? J Bone Jt Surg Br 90(6):778–785. https://doi.org/10.1302/0301-620X.90B6.19809

    Article  CAS  Google Scholar 

  23. Ruch DS, Vallee J, Poehling GG, Smith BP, Kuzma GR (2004) Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures. Arthroscopy 20(3):225–230. https://doi.org/10.1016/j.arthro.2004.01.010

    Article  PubMed  Google Scholar 

  24. Doi K, Hattori Y, Otsuka K, Abe Y, Yamamoto H (1999) Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation. J Bone Jt Surg Am 81(8):1093–1110. https://doi.org/10.2106/00004623-199908000-00005

    Article  CAS  Google Scholar 

  25. Yamazaki H, Uchiyama S, Komatsu M, Hashimoto S, Kobayashi Y, Sakurai T, Kato H (2015) 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 Jt J 97-B(7):957–962. https://doi.org/10.1302/0301-620X.97B7.35354

    Article  CAS  Google Scholar 

  26. Leclercq C, Mathoulin C, Members of E (2016) Complications of wrist arthroscopy: a multicenter study based on 10,107 arthroscopies. J Wrist Surg 5(4):320–326. https://doi.org/10.1055/s-0036-1584163

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lindau T (2017) Arthroscopic evaluation of associated soft tissue injuries in distal radius fractures. Hand Clin 33(4):651–658. https://doi.org/10.1016/j.hcl.2017.07.015

    Article  PubMed  Google Scholar 

  28. Adolfsson L, Jorgsholm P (1998) Arthroscopically-assisted reduction of intra-articular fractures of the distal radius. J Hand Surg Br 23(3):391–395. https://doi.org/10.1016/s0266-7681(98)80065-x

    Article  CAS  PubMed  Google Scholar 

  29. Richards RS, Bennett JD, Roth JH, Milne K Jr (1997) Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am 22(5):772–776. https://doi.org/10.1016/S0363-5023(97)80068-8

    Article  CAS  PubMed  Google Scholar 

  30. Lindau T, Adlercreutz C, Aspenberg P (2000) Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg Am 25(3):464–468. https://doi.org/10.1053/jhsu.2000.6467

    Article  CAS  PubMed  Google Scholar 

  31. Forward DP, Lindau TR, Melsom DS (2007) Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am 89(11):2334–2340. https://doi.org/10.2106/JBJS.F.01537

    Article  PubMed  Google Scholar 

  32. Shkolnikova J, Harvey J (2018) Wrist arthroscopy in the management of distal radius fractures. Annal Jt 3:77

    Article  Google Scholar 

  33. Khanchandani P, Badia A (2013) Functional outcome of arthroscopic assisted fixation of distal radius fractures. Indian J Orthop 47(3):288–294. https://doi.org/10.4103/0019-5413.109872

    Article  PubMed  PubMed Central  Google Scholar 

  34. Selles CA, Mulders MAM, Colaris JW, van Heijl M, Cleffken BI, Schep NWL (2020) Arthroscopic debridement does not enhance surgical treatment of intra-articular distal radius fractures: a randomized controlled trial. J Hand Surg Eur 45(4):327–332. https://doi.org/10.1177/1753193419866128

    Article  Google Scholar 

  35. Bain GI, Munt J, Turner PC, Bergman J (2008) Arthroscopic dorsal capsular release in the wrist: a new technique. Tech Hand Up Extrem Surg 12(3):191–194. https://doi.org/10.1097/BTH.0b013e3181839bb4

    Article  PubMed  Google Scholar 

  36. Bosch U (2002) Arthrofibrosis. Orthopade 31(8):785–790. https://doi.org/10.1007/s00132-002-0336-7

    Article  CAS  PubMed  Google Scholar 

  37. Lee SK, Gargano F, Hausman MR (2006) Wrist arthrofibrosis. Hand Clin 22(4):529–538. https://doi.org/10.1016/j.hcl.2006.09.002 (abstract vii)

    Article  PubMed  Google Scholar 

  38. Steplewski A, Fertala J, Beredjiklian PK, Abboud JA, Wang MLY, Namdari S, Barlow J, Rivlin M, Arnold WV, Kostas J, Hou C, Fertala A (2017) Blocking collagen fibril formation in injured knees reduces flexion contracture in a rabbit model. J Orthop Res 35(5):1038–1046. https://doi.org/10.1002/jor.23369

    Article  CAS  PubMed  Google Scholar 

  39. Tang X, Teng S, Petri M, Krettek C, Liu C, Jagodzinski M (2018) The effect of anti-inflammatory and antifibrotic agents on fibroblasts obtained from arthrofibrotic tissue: an in vitro and in vivo study. Bone Jt Res 7(3):213–222. https://doi.org/10.1302/2046-3758.73.BJR-2017-0219.R2

    Article  CAS  Google Scholar 

  40. Verhellen R, Bain GI (2000) Arthroscopic capsular release for contracture of the wrist: a new technique. Arthroscopy 16(1):106–110. https://doi.org/10.1016/s0749-8063(00)90137-3

    Article  CAS  PubMed  Google Scholar 

  41. Hattori T, Tsunoda K, Watanabe K, Nakao E, Hirata H, Nakamura R (2006) Arthroscopic mobilization for contracture of the wrist. Arthroscopy 22(8):850–854. https://doi.org/10.1016/j.arthro.2006.04.099

    Article  PubMed  Google Scholar 

  42. Luchetti R, Atzei A, Fairplay T (2007) Arthroscopic wrist arthrolysis after wrist fracture. Arthroscopy 23(3):255–260. https://doi.org/10.1016/j.arthro.2006.11.001

    Article  PubMed  Google Scholar 

  43. Zeckey C, Spath A, Kieslich S, Kammerlander C, Bocker W, Weigert M, Neuerburg C (2020) Early mobilization versus splinting after surgical management of distal radius fractures. Dtsch Arztebl Int 117(26):445–451. https://doi.org/10.3238/arztebl.2020.0445

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. University Hospital for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    Gernot Schmidle, Stefan Benedikt, Tobias Kastenberger, Peter Kaiser, Rohit Arora & Markus Gabl

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  1. Gernot Schmidle
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  2. Stefan Benedikt
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Correspondence to Gernot Schmidle.

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Gernot Schmidle, Stefan Benedikt, Tobias Kastenberger, Peter Kaiser, Rohit Arora, and Markus Gabl declare that they have no conflict of interest.

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The study was approved by the local ethics committee (ethics committee of the Medical University Innsbruck, AN 20131161 323/4.2).

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Schmidle, G., Benedikt, S., Kastenberger, T. et al. Arthroscopic debridement of the dorsal capsule in intraarticular distal radius fractures: does it provide superior outcomes?. Arch Orthop Trauma Surg 142, 691–699 (2022). https://doi.org/10.1007/s00402-021-04246-8

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