The application of indirect reduction techniques in the distal radius: Therole of adjuvant arthroscopy

Purpose: The re-establishment of distal radius alignment and articular cong ruency after fracture has been approached by a variety of methods in order to limit injury sequelae such as degenerative osteoarthritis. Although arth roscopy has been beneficial for other articular fractures, it is unclear to what degree arthroscopy should be used for treatment of distal radius arti cular fractures, especially when avoiding full-open procedures that can pro mote arthrofibrosis. The purpose of this study was to determine the utility of adjuvant wrist arthroscopy and whether a diagnostic benefit is observed during: treatment. Type of Study: A modified protocol for treatment of int ra-articular distal radius fractures was developed in a crossover trial fas hion for the purposes of this study. Materials and Methods: Thirty-three co nsecutive subjects treated over a 2-year period were included for study. Fr actures were classified according to Melone, treated by indirect reduction techniques under fluoroscopic visualization, stabilized by static external fixation, and supplemented with percutaneous pins or bone graft as needed. The adequacy of reduction under fluoroscopic visualization was assessed by arthroscopic visualization after this initial treatment. Results: 14.3% of type I fractures, 37.5% of type II fractures, 33.3% of type III fractures, and 71.4% of type IV fractures were modified due to arthroscopic visualizat ion after initial treatment by indirect reduction techniques. No subject re quired a full-open procedure for subsequent reduction. Conclusions: Based o n these data, surgical treatment of intra-articular distal radius fractures solely under fluoroscopic visualization appears inadequate to re-establish articular congruency. Adjuvant wrist arthroscopy provides a diagnostic ben efit in determining whether distal radius articular fracture reduction is a dequate and may also translate to direct improvement in patient satisfactio n and outcome by limiting injury sequelae. When considering indirect reduct ion techniques for distal radius articular injury, we recommend routine art hroscopic evaluation to verify and assist in re-establishment of articular congruency.