Abstract
Introduction
The objective of this study was to compare the articular reduction in two groups of patients with a distal articular radius fracture who underwent surgery with versus without arthroscopic assistance. The initial hypothesis of this study is that arthroscopic assistance does not improve reduction in distal articular radius fractures.
Methods
The study was retrospective (1/04/2014–01/04/2017) and included 41 patients: 23 had arthroscopically assisted osteosynthesis, and 18 had not. All patients included had CT before and 3 months after surgery. All radiographic and CT measurements were retrospectively taken by an independent radiologist who did not know which operative technique was performed. Secondary judgement criteria were clinical analysis at 1-year follow-up and tourniquet time. We also reported all soft tissue injuries diagnosed and repaired and postoperative complications.
Results
At the third month, articular step was 0.91 ± 1.25 mm (arthroscopy) and 1.41 ± 1.68 mm (no arthroscopy), without statistical difference (p = 0.3756). No difference was found for articular gap between the two groups [arthroscopy (0.55 ± 1.04 mm), (no arthroscopy (0.82 ± 1.54 mm)] (p = 0.8574). Except for the tourniquet time, clinical results at 1-year follow-up were not different. One patient of each group had a scapholunate pinning, and 6 patients of the arthroscopy group had a TFCC 1B injury, which was repaired.
Conclusion
This study did not demonstrate that arthroscopic assistance improves step and gap reduction of articular distal radius fracture, confirming initial hypothesis and recent literature data.
Level of evidence
Retrospective, III.
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References
Hardy P, Gomes N, Chebil M, Bauer T (2006) Wrist arthroscopy and intra-articular fractures of the distal radius in young adults. Knee Surg Sports Traumatol Arthrosc 14:1225–1230. https://doi.org/10.1007/s00167-006-0123-9
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 Joint Surg Br 90:778–785. https://doi.org/10.1302/0301-620X.90B6.19809
Abe Y, Tsubone T, Tominaga Y (2008) Plate presetting arthroscopic reduction technique for the distal radius fractures. Tech Hand Up Extrem Surg 12:136–143. https://doi.org/10.1097/BTH.0b013e3181670fe3
Levy S, Saddiki R, Normand J, Dehoux E, Harisboure A (2011) Arthroscopic assessment of articular fractures of distal radius osteosyntheses by percutaneous pins. Chir Main 30:218–223. https://doi.org/10.1016/j.main.2011.04.004
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 Joint J 97-B:957–962. https://doi.org/10.1302/0301-620x.97b7.35354
Thiart M, Ikram A, Lamberts RP (2016) How well can step-off and gap distances be reduced when treating intra-articular distal radius fractures with fragment specific fixation when using fluoroscopy. Orthop Traumatol Surg Res 102:1001–1004. https://doi.org/10.1016/j.otsr.2016.09.005
Liverneaux P, Ichihara S, Facca S, Hidalgo Diaz J (2016) Résultats de l’ostéosynthèse par plaque antérieure et abord mini-invasif (MIPO) des fractures de l’extrémité distale du radius: mise au point. Hand Surg Rehabil 35S:S80–S85
Igeta Y, Vernet P, Facca S, Naroura I, Diaz JJH, Liverneaux PA (2018) The minimally invasive flexor carpi radialis approach: a new perspective for distal radius fractures. Eur J Orthop Surg Traumatol. https://doi.org/10.1007/s00590-018-2124-z
Mathoulin C, Sbihi A, Panciera P (2001) Interest in wrist arthroscopy for treatment of articular fractures of the distal radius: report of 27 cases. Chir Main 20:342–350
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 89:2334–2340. https://doi.org/10.2106/JBJS.F.01537
Hohendorff B, Eck M, Mühldorfer M, Fodor S, Schmitt R, Prommersberger K-J (2009) Palmar wrist arthroscopy for evaluation of concomitant carpal lesions in operative treatment of distal intraarticular radius fractures. Handchir Mikrochir Plast Chir 41:295–299. https://doi.org/10.1055/s-0029-1238309
Lindau T (2017) Arthroscopic evaluation of associated soft tissue injuries in distal radius fractures. Hand Clin 33:651–658. https://doi.org/10.1016/j.hcl.2017.07.015
Fontès D (2016) Pathology of the triangular fibrocartilaginous complex in distal radius fractures. Hand Surg Rehabil 35S:S60–S68. https://doi.org/10.1016/j.hansur.2016.01.009
Khanchandani P, Badia A (2013) Functional outcome of arthroscopic assisted fixation of distal radius fractures. Indian J Orthop 47:288–294. https://doi.org/10.4103/0019-5413.109872
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 Joint Surg Am 78:357–365
Burnier M, Herzberg G, Izem Y, Joulie S (2013) Traitement des fractures articulaires du radius distal sous arthroscopie: le but anatomique est-il atteint? Revue de Chirurgie Orthopédique et Traumatologique 99:e22. https://doi.org/10.1016/j.rcot.2013.10.061
Christiaens N, Nedellec G, Guerre E, Guillou J, Demondion X, Fontaine C, Chantelot C (2017) Contribution of arthroscopy to the treatment of intraarticular fracture of the distal radius: retrospective study of 40 cases. Hand Surg Rehabil. https://doi.org/10.1016/j.hansur.2017.03.003
Müller ME, Nazarian S, Koch P (1987) Part 2: Classification AO des Fractures: Tome I: les os Longs, 1st edn. Springer, Berlin
Atzei A, Luchetti R, Sgarbossa A, Carità E, Llusà M (2006) Set-up, portals and normal exploration in wrist arthroscopy. Chir Main 25S1:S131–S144. https://doi.org/10.1016/j.main.2006.07.029
Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 14:594–606
Bain GI, Munt J, Turner PC (2008) New advances in wrist arthroscopy. Arthroscopy 24:355–367. https://doi.org/10.1016/j.arthro.2007.11.002
Cooney WP, Bussey R, Dobyns JH, Linscheid RL (1987) Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 214:136–147
Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608. https://doi.org/10.1002/(SICI)1097-0274(199606)29:6%3c602:AID-AJIM4%3e3.0.CO;2-L
Arora S, Grover SB, Batra S, Sharma VK (2010) Comparative evaluation of postreduction intra-articular distal radial fractures by radiographs and multidetector computed tomography. J Bone Joint Surg Am 92:2523–2532. https://doi.org/10.2106/JBJS.I.01617
Cole RJ, Bindra RR, Evanoff BA, Gilula LA, Yamaguchi K, Gelberman RH (1997) Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg Am 22:792–800
Hunt JJ, Lumsdaine W, Attia J, Balogh ZJ (2013) AO type-C distal radius fractures: the influence of computed tomography on surgeon’s decision-making. ANZ J Surg 83:676–678. https://doi.org/10.1111/j.1445-2197.2012.06311.x
Heo YM, Roh J-Y, Kim S-B, Yi JW, Kim KK, Oh BH, Oh H-T (2012) Evaluation of the sigmoid notch involvement in the intra-articular distal radius fractures: the efficacy of computed tomography compared with plain X-ray. Clin Orthop Surg 4:83–90. https://doi.org/10.4055/cios.2012.4.1.83
Zemirline A, Taleb C, Facca S, Liverneaux P (2014) Minimally invasive surgery of distal radius fractures: a series of 20 cases using a 15 mm anterior approach and arthroscopy. Chir Main 33:263–271. https://doi.org/10.1016/j.main.2014.04.007
Swart E, Tang P (2017) The effect of ligament injuries on outcomes of operatively treated distal radius fractures. Am J Orthop 46:E41–E46
Gehrmann SV, Windolf J, Kaufmann RA (2008) Distal radius fracture management in elderly patients: a literature review. J Hand Surg 33:421–429. https://doi.org/10.1016/j.jhsa.2007.12.016
Lebailly F, Zemirline A, Facca S, Gouzou S, Liverneaux P (2014) Distal radius fixation through a mini-invasive approach of 15 mm. PART 1: a series of 144 cases. Eur J Orthop Surg Traumatol 24:877–890. https://doi.org/10.1007/s00590-013-1363-2
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MS: Main author—acquisiton of data and manuscript writing. PEW: Secondary author—acquisition of data. VM: Analysis of data. EG: Interpretation of data, revision of manuscript. CC: revision of manuscript, study conception. ME: Data interpretation, critical revision, study conception. TB: Data interpretation, study conception.
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The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
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All procedures performed in this study, involving human participants, were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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Saab, M., Wunenburger, PE., Guerre, E. et al. Does arthroscopic assistance improve reduction in distal articular radius fracture? A retrospective comparative study using a blind CT assessment. Eur J Orthop Surg Traumatol 29, 405–411 (2019). https://doi.org/10.1007/s00590-018-2348-y
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DOI: https://doi.org/10.1007/s00590-018-2348-y