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Arthroscopy failed to aid fragment-specific fixation of distal radius fractures
Arthroscopy helped researchers identify additional pathologies in one-third of patients, but they contend fluoroscopy is just as useful.
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SAN FRANCISCO — Arthroscopy did not aid in the reduction of intraarticular distal radius fractures when combined with fragment specific fixation, according to a recently presented study.
“Arthroscopy was of limited value because the gaps and stepoff we found were less than 2 mm, which we deem acceptable,” Mari Thiart, MBBS, of the University of Stellenbosch, South Africa, said during her presentation at the American Society for Surgery of the Hand Annual Meeting.
Intraarticular fractures studied
The researchers included patients admitted to their institution for intraarticular distal radius fractures. If the fractures were too complex for a volar plate, the researchers included them in this study, according to Thiart. In all, there were 70 patients with an average age of 41 years. The majority of patients were women and right-hand dominant, although most patients had left-hand injuries, she said.
In 41% of patients the mechanism of injury was a low-energy fall and 27% of patients fell from a height. The other injuries were due to motor vehicle crashes in 23% of patients, assault in 6% of patients and sports injuries in 3% of patients. Fifty-five patients had Müller AO class C fractures.
Images: Thiart M
Thiart and colleagues reduced the fractures and fixed them with Radial Column Pin Plates, Dorsal Ulnar Pin Plates or Dorsal or Volar Buttress Pins (TriMed Inc; Aurora, Colo., USA). About 66% of patients required a fixation device on the radial styloid and on the dorsal ulnar column, according to Thiart.
“Only 20% of patients needed a volar fixation device, which is different from our traditional teaching of volar plating,” she said.
Procedure described
The investigators made the first incision from the tip of the radial styloid extending 7 cm to 10 cm and then reduced the radial styloid, according to Thiart.
“Depending on what we found on CT scan, the patient got a dorsal ulnar incision or a volar incision depending on fracture pattern,” she said.
The researchers examined the fractures for adequate reduction, placed patients in finger traps and inserted a dry scope in the radiocarpal joint to evaluate the reduction for gaps or stepoff. They inserted a 19-gauge hollow needle as a size reference, Thiart said.
Gaps, stepoff
The researchers noted 14% of patients had gaps greater than 1 mm and 23% of patients had stepoffs that were greater than 1 mm. They found such additional pathologies as triangular fibrocartilage complex (TFCC) tears in one-third of patients, cartilage damage in five patients, scapholunate tears in three patients, and one patient each with a capsular tear and an undisplaced scaphoid fracture.
Four patients with the additional pathologies required treatment. This included one patient whose fracture was repositioned for a stepoff of greater than 3 mm, one patient with a TFCC tear repair done for an unstable distal radial ulnar joint after fracture reduction, one patient whose K-wire was repositioned and one patient with a scaphoid fracture reduction.
“There has been a long-term correlation between stepoff and symptomatic osteoarthritis,” Thiart said. “The literature has shown that fluoroscopy is as good as arthroscopy at detecting stepoff,” she said. – by Renee Blisard Buddle
- Reference:
- Thiart M. Paper #5. Presented at: American Society for Surgery of the Hand Annual Meeting. Oct. 3-5, 2013; San Francisco.
- For more information:
- Mari Thiart, MBBS, can be reached at University of Stellenbosch, Stellenbosch Central, Stellenbosch 7600 South Africa; email: mari.thiart18@gmail.com.
Disclosure: Thiart has no relevant financial disclosures.