J Korean Orthop Assoc.  2009 Apr;44(2):233-239.

Management of Comminuted Intra-articular Fractures of the Distal Radius: Arthroscopically Assisted Reduction and Pin Fixation Supplemented with External Fixation

• Kim JP
• Yu HJ

Abstract

PURPOSE
Here we report the clinical results of arthroscopically assisted reduction and pin fixation supplemented with an external fixator for the treatment of comminuted intra-articular fractures of the distal radius. MATERIALS AND METHODS: Thirty-seven patients with a minimum follow-up period of 1 year were enrolled. Radiographs obtained immediately after surgery and those obtained after osseous union were compared and analyzed. The objective and subjective function of the wrist were evaluated. The overall outcomes were assessed using a modified Green and O'Brien system. RESULTS: Eleven patients had an excellent outcome, 20 good, 4 fair and 2 poor. Loss of radial shortening, radial inclination, step-off, and a gap between the radiographs obtained immediately after surgery and at osseous union were not significant. The volar tilt angle of the final follow-up evaluation averaged 4.6degrees, which was significantly different compared to the contralateral side. The mean range of motion of the wrist ranged from 73% to 92%. The mean grip strength was 73% compared to the uninjured contralateral wrist. The mean DASH and PRWE outcome scores were 49.2 (range 35-67) and 31.0 (range 13-73), respectively. CONCLUSION: Arthroscopic reduction and pin fixation supplemented with an external fixator, for the treatment of comminuted intra-articular fractures of the distal radius, allows for accurate articular reduction to be established and maintained.

Keyword

Distal radius; Intra-articular fracture; Arthroscopic reduction; External fixation

MeSH Terms

External Fixators
Follow-Up Studies
Hand Strength
Humans
Intra-Articular Fractures
Radius
Range of Motion, Articular
Wrist

Figure

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  Fig. 1 (A) Preoperative radiographs of 50-year-old male patient who fell showing an AO type C3 distal radius fracture of his left wrist. (B) Arthroscopic examination revealed intraarticular impaction and gap formation. (C) The view through the midcarpal portal shows a grade II tear of the scapholunate interosseous ligament. (D) Arthroscopic image shows the restoration of the articular surface after reduction and pin fixation. (E) Arthroscopically assisted reduction and percutaneous pinning for the scapholunate interosseous ligament injury was performed. The ulnar styloid fracture was stabilized with a tension band wiring technique. (F) The postoperative 14-months radiographs show satisfactory healing.

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