Contribution of arthroscopy to the treatment of intraarticular fracture of the distal radius: Retrospective study of 40 cases

Christiaens, Nicolas; Nedellec, G.; Guerre, Elvire; Guillou, J.; Demondion, Xavier; Fontaine, C.; Chantelot, Christophe

doi:10.1016/j.hansur.2017.03.003

Cited by 20 publications

(24 citation statements)

References 39 publications

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“…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. 12…”

Section: Discussionmentioning

confidence: 99%

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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: 99%

“…Primary arthroscopically-assisted reduction and internal fixation (AARIF) of intra-articular DRF has recently showed better reduction of both the scaphoid and lunate facets when compared with only fluoroscopic reduction. 9 10 However, none of these studies assessed the value of AARIF for AO type B3 or C fractures when VRFs were present.…”

mentioning

confidence: 99%

Arthroscopically Assisted Treatment of Volar Rim Fractures

Herzberg¹,

Burnier

2021

J Wrist Surg

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“…25,26 Wrist arthroscopy during DRF ORIF has been proposed to assist in reduction of the articular surface. 27,28 A recent literature review determined wrist arthroscopy to be more beneficial in diagnosis of concomitant ligamentous injuries rather than for articular reduction, although some studies do show a benefit in reduction quality. 29 Quality of intra-articular reduction as a predictor of postoperative functional outcome may not be as crucial as other aspects of DRF reduction.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Operative Time Associated with Increased Healthcare Utilization after Open Reduction and Internal Fixation of Intra-Articular and Extra-Articular Distal Radial Fractures: An Analysis of 17,482 Cases

et al. 2021

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Background The current literature does not contain a quantitative description of the associations between operative time and adverse outcomes after open reduction and internal fixation (ORIF) of distal radial fractures (DRF). Questions/Purpose We aimed to quantify associations between DRF ORIF operative time and 1) 30-day postoperative health care utilization and 2) the incidence of local wound complications. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for DRF ORIF cases (January 2012–December 2018). A total of 17,482 cases were identified. Primary outcomes included health care utilization (length of stay [LOS], discharge dispositions, 30-day readmissions, and reoperations) per operative-time category. Secondary outcome was incidence of wound complications per operative-time category. Multivariate regression was conducted to determine operative-time categories associated with increased risk while adjusting for demographics, comorbidities, and fracture type. Spline regression models were constructed to visualize associations. Results The 121 to 140-minute category was associated with significantly higher risk of a LOS > 2 days (odds ration [OR]: 1.64; 95% confidence interval [CI]:1.1–2.45; p = 0.014) and nonhome discharge (OR: 1.72; 95% CI:1.09–2.72; p = 0.02) versus 41 to 60-minute category. The ≥ 180-minute category exhibited highest odds of LOS > 2 days (OR: 2.08; 95%CI: 1.33–3.26; p = 0.001), nonhome discharge disposition (OR: 1.87; 95% CI: 1.05–3.33; p = 0.035), and 30-day reoperation occurrence (OR: 3.52; 95% CI: 1.59–7.79; p = 0.002). There was no association between operative time and 30-day readmission (p > 0.05 each). Higher odds of any-wound complication was first detected at 81 to 100-minute category (OR: 3.02; 95% CI: 1.08–8.4; p = 0.035) and peaked ≥ 181 minutes (OR: 9.62; 95% CI: 2.57–36.0; p = 0.001). Spline regression demonstrated no increase in risk of adverse outcomes if operative times were 50 minutes or less. Conclusion Our findings demonstrate that prolonged operative time is correlated with increased odds of health care utilization and wound complications after DRF ORIF. Operative times greater than 60 minutes seem to carry higher odds of postoperative complications.

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“…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%

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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Contribution of arthroscopy to the treatment of intraarticular fracture of the distal radius: Retrospective study of 40 cases

Cited by 20 publications

References 39 publications

Arthroscopically Assisted Treatment of Volar Rim Fractures

Arthroscopically Assisted Treatment of Volar Rim Fractures

Prolonged Operative Time Associated with Increased Healthcare Utilization after Open Reduction and Internal Fixation of Intra-Articular and Extra-Articular Distal Radial Fractures: An Analysis of 17,482 Cases

Arthroscopic assisted treatment of distal radius fractures and concomitant injuries

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