Intra-articular distal radius fractures: Arthroscopic assessment of radiographically assisted reduction

The optimal means of assessing articular displacement during closed reducti on of distal radius fractures is unknown. The purpose of this study was to evaluate the in vivo accuracy of fluoroscopy (C-arm) and plain radiographs (XR) in measuring articular step-off and gap and to determine if postreduct ion arthroscopy can identify malreduced intra-articular fractures that woul d benefit from reduction. Fifteen intra-articular distal radius fractures u nderwent closed manipulation and percutaneous pinning. Reduction was assess ed sequentially by C-arm, XR, and wrist arthroscopy. The width of gapping b etween articular surface fragments was underestimated to a statistically si gnificant degree by both C-arm and XR. The magnitude of articular step-off measured with arthroscopy was not statistically different than that measure d radiographically. In 5 (33%) cases, the optimal reduction obtained using C-arm and XR was found to have an articular displacement of >1 mm by adjunc tive arthroscopy. Complete reduction and pinning was performed with satisfa ctory results. These results suggest that adjunctive arthroscopy may detect residual gapping of the articular surface that is not seen by C-arm or XR. Residual displacement noted by adjunctive arthroscopy may prompt another r eduction effort and result in an improved articular alignment of intra-arti cular distal radius fractures. Copyright (C) 2001 by the American Society f or Surgery of the Hand.