Arthroscopic study of injuries in articular fractures of distal radius extremity

Abstract

OBJECTIVE: To analyze the incidence of wrist ligament and cartilage associated fractures of the distal radius, through arthroscopy, correlating with AO/ASIF classification. METHODS: Thirty patients aged between 20 and 50 years old, with closed fracture from groups B and C according to AO/ASIF classification were selected. All of them were submitted to wrist arthroscopy to address intra-articular injuries and reduction and osteosynthesis of the fracture. RESULTS: A high incidence of intra-articular injuries was noticed, and 76.6% of them presented injury of the triangular fibrocartilage complex, 36.6% of the intrinsic scapholunate ligament, 6.6% of the intrinsic triquetrolunate ligament, and 33% articular cartilage injury larger than three millimeters. Patients with fractures from type C according to AO/ASIF classification presented a higher incidence of ligament injuries. CONCLUSION: There is no relationship between the presence of chondral injury and the AO/ASIF classification of the fractures in the cases reported in this study. Level of Evidence III, Non Randomized Controlled Trial.

Open Treatment of Acute Scapholunate Instability

“…[50][51][52][53][54][55][56] Rates when diagnosed radiographically range from 13.3% to 29%. [57][58][59][60][61][62] Mudgal and Hastings suggest the mechanism of this combined injury can be attributed to a combination of tensile stress in ulnar deviation and axial (compression) stress in either radial or ulnar deviation.…”

“…63,64 Overall, intra-articular fractures are associated with higher rates of SL injury but SL injury can be found in extra-articular fractures as well. [50][51][52][53][54][57][58][59][60]62 Diagnosis of these concomitant injuries can be difficult. In 1997, Richards and colleagues 54 evaluated 118 distal radius fractures arthroscopically and found that 60% of patients with SL injury did not demonstrate an SL gap greater than 2 mm on radiographs.…”

Apport de l’arthroscopie dans la prise en charge des fractures articulaires du radius distal. État actuel des connaissances à propos d’une revue systématique de 10 ans de la littérature

“…Neuf études ont un suivi inférieur ou égal à 12 mois [7][8][9]17,[22][23][24][25][26]. Seules 2 études sont comparatives [4,7].…”

“…D'autres études n'ont pas traité les lésions retrouvées [9,20,22]. Considérant la prise en charge, pour certains auteurs le brochage était systématique si une lésion était retrouvée, sans geste associé arthroscopique [4,11,23]. Une étude a réalisé une réparation à ciel ouvert des lésions stade 4 [24].…”

“…Les lésions de type 1B ont été réparées par suture sous arthroscopie, hormis une réparation à ciel ouvert [4]. Les autres types de lésions ont majoritairement relevé d'un débridement arthroscopique [4,7,11,23,24], voire d'un traitement orthopédique pour les lésions 1D [24].…”