Arthroscopy can be performed either before or after initial fracture reduction. Reports with good illustrations showing the technique of arthroscopic fracture reduction are published by Del Pinal et al. Arthroscopy is used to directly visualize any intra-articular gaps and step-offs and fracture reduction under visualization. Therefore, it seems reasonable to invest all effort into adequate intra-articular fracture reduction. Recent findings indicate a critical tolerance for joint incongruity in the distal radius may be as little as 1 mm. Intra-articular DRFs should be reduced anatomically without any persisting steps, as the latter correlates with radiocarpal osteoarthritis and an unsatisfactory result. The radiocarpal joint is typically assessed using the 3/4, 5/6 and 6R portal, and the midcarpal joint using the midcarpal radial and ulnar portals (Fig. The authors use a 2.7 mm probe with a 30° field of view angle. If needed, a pump pressure of 15 mmHg should be sufficient. The surgeon should switch to “wet” arthroscopy when using thermal probes because heat generation may damage the cartilage. If required, the joint can be irrigated using saline to remove debris and blood to increase visibility. One disadvantage is the potential loss of vision due to splashes on the tip of the scope, or blood and debris in the joint. In “dry” wrist arthroscopy, the air valve is kept open to enable free air circulation through the joint and suction should be switched off unless needed. The authors usually use “dry” arthroscopy according to the recommendations of Del Pinal to prevent extravasation, to minimize soft tissue swelling and secondary compartment syndrome. The authors perform arthroscopy in the following cases:įour kg traction weight applied on the wristĪn Esmarch tourniquet on the arm is inflated for exsanguination to 200–250 mm Hg. Few authors even recommend wrist arthroscopy for any kind of DRF. Widening of the DRUJ may hide an injury of the TFCC, which can be verified arthroscopically.Ĭomplex multifragmented intra-articular fractures such as three-part/four-part fractures associated with intra-articular comminution (explosion type fractures) may need arthroscopic evaluation, reduction, and fixation, and in die-punch fractures, arthroscopy is suggested too. Radial styloid fractures (chauffeurs fracture) without the dislocation of the lunate may be part of greater arch injuries described by Mayfield. Radiographic findings may hint to soft tissue injuries e.g., inter-carpal joint space widening or disruption of the Gilula lines. Arthroscopically assisted treatment of DRFs can help detecting and treating scaphoid fractures and/or ligament injuries. The following manuscript discusses the current literature regarding these indications and gives insight into the authors` opinions and practice.Ī main indication for arthroscopy in DRFs is an intra-articular step or gap from 1 to 2 mm after closed reduction, which is a prognostic factor for post traumatic osteoarthritis. ![]() Wrist arthroscopy is used for diagnostic and therapeutic purposes. Indications for arthroscopy in DRFs are multifragmented intra-articular fractures with comminution and/or die-punch fragments, associated carpal bone fractures or obvious intrinsic ligament injuries, an obvious widening of the distal radioulnar joint (DRUJ) suspecting a triangular fibrocartilage complex (TFCC) lesion, and radial styloid fractures because of a potential incomplete greater arch lesion with a SL ligament tear. Over the years, several authors have investigated the benefit of arthroscopy in the treatment of acute DRFs. Wrist arthroscopy in DRFs underwent a cumulative evaluation in the last few decades. Nowadays, plating is the most common surgical treatment method for DRFs. Depending on fracture fragment dislocation, fracture instability criteria, the patient’s needs, and functional demands, treatment can vary between non-surgical treatment with cast immobilization and surgical treatment with open reduction and internal fixation. Distal radius fractures (DRFs) belong to the most common fracture type in humans.
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