Contribution of arthroscopy to the management of intra-articular distal radius fractures: Knowledge update based on a systematic 10-year literature review

Saab, Marc; Guerre, Elvire; Chantelot, Christophe; Clavert, Philippe; Ehlinger, Matthieu; Bauer, Thomas; Sofcot,

doi:10.1016/j.otsr.2019.06.016

Cited by 20 publications

(13 citation statements)

References 30 publications

(126 reference statements)

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“…However, there has not been widespread acceptance of these techniques because of a learning curve, a need for dedicated facilities, and the limited evidence of better clinical results. 18 Two recent studies have confirmed that AARIF and fluoroscopy provide a better reduction of articular fragments when compared with fluoroscopy only. 9 10 Despite considerable interest in VRF, 2 3 4 5 6 and to the best of our knowledge, the only study to assess the improved outcomes of AARIF is by Del Pinal.…”

Section: Discussionmentioning

confidence: 92%

Arthroscopically Assisted Treatment of Volar Rim Fractures

Herzberg¹,

Burnier

2021

J Wrist Surg

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Background Arthroscopically-assisted reduction and internal fixation (AARIF) for distal radius fractures (DRF) has been extensively described. Little information is available about AARIF in AO “B3” and “C” DRF with displaced lunate facet volar rim fragment (VRF) and volar carpal subluxation. However, lunate volar rim fragment (LVRF) may be very difficult to reduce and fix under arthroscopic control using the flexor carpi radialis (FCR) or FCR extended approaches while traction is applied. Purposes The aims were to describe our surgical technique of AARIF of partial or complete DRF with VRF and provide information about how often this technique may be necessary, based on a large DRF database. Methods The dual-window volar approach for complete articular AO C DRF with volar medial fragment was described in 2012 for performing open reduction internal fixation (ORIF). Since 2015, we have used the dual-window approach for AARIF of “B3” or “C” DRF with volar carpal subluxation. We analyzed our PAF database, searching for patients treated with AARIF in “B3” and “C” fractures. Results The dual-window volar approach is very useful when using AARIF for AO “B3” and “C” DRF with displaced VRF and volar carpal subluxation. The anteromedial part of the exposure allows a direct access to reduction and fixation of the LVRF under traction and arthroscopic control. Overall, 1% of all articular DRF in this series showed a displaced LVRF amenable to the dual-window volar approach. Conclusion It is almost impossible to access and properly fix a VRF using traction and arthroscopic control through the FCR or FCR extended FCR approach because of the stretched flexor tendon mass. The use of the dual-window approach during AARIF of AO “B3” or “C” DRF has not previously been reported. Displaced VRF are rare whether they were part of “B3” or “C” fractures. If AARIF is chosen, we strongly recommend the use of the dual-window volar approach for AO “B3” and “C” fractures with VRF. A single anteromedial approach can also be used for isolated “B3” anteromedial DRF.

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Section: Discussionmentioning

confidence: 92%

Arthroscopically Assisted Treatment of Volar Rim Fractures

Herzberg¹,

Burnier

2021

J Wrist Surg

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“…Several studies have been conducted to address the question whether fluoroscopically or arthroscopically assisted reduction leads to a better articular surface restoration regarding the size of steps and gaps. A systematic review including 720 patients with a follow-up of 0-38 months (16 studies; level of evidence II-IV) showed that most studies (13/16) were in favor of arthroscopy, improving articular reduction [33].…”

Section: Assisted Fracture Reductionmentioning

confidence: 99%

“…However, most studies had a small sample size, short follow-up and/or used a case-series design, which is unable to answer the question of articular reconstruction [33]. Table 1 Geissler classification [40] Grade Description…”

Section: Assisted Fracture Reductionmentioning

confidence: 99%

“…reported that only 50% of the studies (6/12 studies; level of evidence II-IV) were in favor of arthroscopy. However yet again, most studies had a small sample size, short follow-up and/or used a case-series design [33].…”

Section: Assisted Fracture Reductionmentioning

confidence: 99%

“…The treatment of grade III injuries remains controversial. Several authors besides Geissler advocate K-wire pinning [33,[51][52][53][54][55]. However, there were no differences found in the subjective, objective, or radiographic outcome after grade III and grade I/II untreated tears associated with displaced DRFs [49].…”

Section: Sl and Lt Ligament Injuriesmentioning

confidence: 99%

See 2 more Smart Citations

Arthroscopic assisted treatment of distal radius fractures and concomitant injuries

Kastenberger

Kaiser

Schmidle

et al. 2020

Arch Orthop Trauma Surg

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Wrist arthroscopy is mainly used to assist fracture reduction and fixation and to diagnose and treat concomitant injuries mainly to the scapholunate (SL), lunotriquetral (LT) ligament and the triangular fibrocartilage complex (TFCC). Arthroscopy is beneficial in improving anatomical reduction of fracture steps and gaps in intra-articular distal radius fractures (DRFs). Yet, the literature that the functional outcome correlates with the use of arthroscopy, is limited. Non-surgical treatment and immobilization is recommended for Geissler grade I-III Sl-ligament injuries, while open reduction, ligament suture and/ or K-wire pinning is mandatory for complete ligament tears according to Geissler grade IV. This manuscript describes the current literature and gives insight into the authors' opinions and practice.

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