Current aspects in the arthroscopic treatment of shoulder instability

With regard to postoperative stability of the shoulder joint, the results yielded by the various arthroscopic refixation techniques are not as good as those obtained after open operation. The aim of this paper is to analyze the reasons for this and to present a new procedure which it is hoped will improve the arthroscopic results. The main reason for the high postoperative recurrence rate after arthroscopic joint stabilization seems to be that refixation of the capsule is not performed at the level of the lesion, but above it, because of the position of the subscapularis tendon. Another reason for the poor results of arthroscopy is that the enlarged capsule cannot be shortened as desired, because the glenoid labrum is used for refixation of the capsule. To improve the arthroscopic results we suggest basic changes of the procedure in cases with severe damage to the soft tissue at the antero-inferior aspect of the glenoid and/or in cases with an enlarged capsule: refixation of the capsule should not be carried out from inside the joint but from outside the capsule. To this end, we applied the so-called extraarticular screwing technique. Refixation is achieved by inserting small cannulated titanium screws by means of a special screwdriver. No metal is placed inside the joint. This technique requires a new portal, namely the so-called antero-inferior portal, which is placed 1.5 cm inferior to the coracoid process. If the precautionary measures described are duly observed, the musculocutaneous nerve cannot be damaged. The technique allows stable refixation of the capsule in the desired length by placement of one or two small screws in the center of the Bankart lesion. Our preference is based on experience with 83 patients with recurrent shoulder instability who were operated on by arthroscopic techniques.(ABSTRACT TRUNCATED AT 250 WORDS)     

Arthroscopic reduction and headless cannulated compression screw fixation of adults' tibial eminence fractures

Adults' displaced tibial eminence fractures are often treated surgically. Difficulties commonly experi enced with surgical techniques include joint motion limitation, need for cautious postoperative rehabilitation, and intra-articular hardware prominence Here I present a displaced tibial eminence fracture he operative leg is placed in a leg holder, and th technique of arthroscopic reduction and internal fixation with headless cannulated compression screws. This technique allows for aggressive rehabilitation for prevention of joint motion limitation and eliminates the need for hardware removal.     

SPin微型螺钉治疗手指关节内骨折

目的 探讨应用Spin螺钉治疗手指关节内骨折的方法及其临床疗效.方法 2004年10月至2007年10月,应用Spin螺钉治疗手指关节内骨折22例,男15例,女7例;年龄18～65岁,平均31岁.涉及掌指关节内骨折9例,近侧指间关节内骨折11例,远侧指间关节内骨折2例.开放性骨折9例,闭合性骨折13例.开放性损伤中合并肌腱损伤7例,1例合并拇指末节离断.采用1枚Spin螺钉内固定14例,采用2枚Spin螺钉内固定5例,采用1枚Spin螺钉并克氏针内固定3例.术后2周开始进行早期功能锻炼.结果 术后伤口均一期愈合,经6～12个月(平均8个月)的随访,无伤口感染及骨髓炎发生.所有病例骨折均愈合,临床愈合时间为3～6周,骨性愈合时间为7～12周,内固定拆除时间为8～26周,无创伤性关节炎发生.手指关节活动度按TAM法进行评价,优15例、良5例、中1例、差1例,优良率90.9%.其中掌指关节内骨折9例.8例活动度0°～90°,1例活动度O°～75°;近侧指间关节内骨折11例,8例活动度0°～11°.,2例活动度O°～90°,1例活动度0°～50°;远侧指间关节内骨折2例,活动度0°～50°.结论 对于手指关节内骨折,行切开复位,Spin螺钉内固定,具有固定可靠、复位满意等优点,是一种有效的手术方法.选择合适的适应证,熟练的手术技巧及早期功能锻炼可以获得满意的疗效.     

Percutaneous screw fixation for the acetabular fracture with quadrilateral plate involved by three-dimensional fluoroscopy navigation: surgical technique

BackgroundThe percutaneous three-dimensional (3D)-fluoroscopic-navigated screw directing to the quadrilateral plate was attempted.Materials and methodsFive patients with acetabular fractures were treated by 3D navigated percutaneous screw. The quadrilateral plate was involved in all the patients. The Arcadis 3D (ARCADIS Orbic 3D^®; Siemens AG Healthcare Sector, Erlangen, Germany) and computer navigation system (stryker navigation system) were employed, screwing trajectory was attempted to anchor the quadrilateral plate perpendicularly to the fracture line and close to the joint cartilage as much as possible. Parameters including fracture gap closure (P1), distance to the joint cartilage (P2), angulations between the screw and the fracture line (P3), were measured with the software installed on the machine of Arcadis 3D.ResultSeven screws were inserted with the use of 3D fluoroscopic navigation. The quadrilateral plate was hold by percutaneous screws. The closure of fracture gap was achieved in 3 patients by 2–3 mm. The nearest distance from the screw to the joint cartilage was ranged from <1 mm to 6 mm. The angulations between the screw and the fracture line was 80–90° in three patients, it was 60° and 65° respectively on the rest two patients. All patients felt pain free 1 week after the operation. No complication was noted postoperatively.ConclusionThe surgical technique of percutaneous screwing for the acetabular fracture with three-dimensional fluoroscopy-based navigation was demonstrated.     

Arthroscopic assisted internal fixation of certain fractures about the knee

A technique is presented by which single-fragment, major intra-articular fractures about the knee can be reduced anatomically under arthroscopic control and internally fixed with percutaneously placed cancellous screws. A displaced intra-articular fracture of the femoral condyle and a tibial plateau fracture were treated utilizing this technique. Both patients obtained excellent results with rapid return of function of the injured limb.     

Percutaneous,arthroscopically-assisted osteosynthesis of calcaneus fractures

BACKGROUND: The development of major and minor wound complications is a major concern in the open reduction and internal fixation of displaced intra-articular calcaneus fractures. Percutaneous, arthroscopically assisted screw osteosynthesis was developed to minimize the surgical approach without risking inadequate reduction of the subtalar joint. The method was applied in selected cases of displaced intra-articular calcaneus fractures with one fracture line crossing the posterior calcaneal facet (Sanders type II fractures). METHODS: Between March 1998 and July 2000, 15 patients were treated with that method. Percutaneous leverage was carried out with a Schanz screw introduced into the tuberosity fragment (the Westhues maneuver) under direct arthroscopic and fluoroscopic control. After anatomic reduction was achieved, the fragments were fixed with three to six cancellous screws introduced via stab incisions. RESULTS: The functional results of 10 patients at a minimum of 1 year follow-up are good to excellent, with an average AOFAS ankle-hindfoot score of 93.7 (range 87-100) and an average Maryland Foot Score of 95.8 (range 93-100). Overall patient comfort and satisfaction were superior to open reduction for similar fracture patterns, and the in-hospital time could be reduced. CONCLUSIONS: Percutaneous, arthroscopically assisted osteosynthesis offers exact assessment of the articular surface and allows anatomical reduction while adhering to the principles of minimally invasive surgery. The short-term results are excellent, while long-term results with greater patient cohorts are awaited.     

Wrist arthroscopy in distal radial fractures using a modified horizontal technique

Wrist arthroscopy has today become an important adjunct in the management of displaced intra-articular distal radial fractures, with reduction of joint incongruencies as well as detection and treatment of associated soft-tissue injuries. However, standard upright arthroscopy makes it difficult to combine arthroscopic-assisted reduction with additional treatment of the often comminuted, extra-articular fracture component. This article describes a modified arthroscopic technique in which the arm is blocked in pronation with the traction horizontally over a handle on a normal hand table, without any other changes in the arthroscopy itself. The author has operated on 17 patients using this horizontal technique in combination with arthroscopic-assisted reductions, closed and open osteosynthesis, and soft-tissue procedures. The horizontal technique allows complete treatment of comminuted, unstable distal radial fractures, intra-articular and extra-articular reduction, and bone grafting, as well as assessment and treatment of associated soft-tissue injuries.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 1 (January), 2001: pp E5–E5     

Arthroscopic Extracapsular Plication to Treat Multidirectional Instability of the Shoulder

Successful arthroscopic treatment of multidirectional shoulder instability requires that the surgeon reduce the volume of the capsule. This goal can be achieved by using the extracapsular plication technique. There are several advantages to using pancapsular plication and an intra-articular knot. Much better potential for capsular healing exists when the outer layer of the capsule, which is composed of fibrous tissue, is tied extra-articularly. With the intra-articular plication technique, the inner layer of the capsule is synovia, which has less healing capacity. The amount of capsule plication that can be achieved with the extra-articular plication technique exceeds what is possible with the intra-articular plication technique. This is very important in patients who have a large degree of instability in the anterior, the posterior, and, particularly, the inferior direction. Thermal capsulorrhaphy enhances other arthroscopic stabilization procedures. Thermal striping helps to reduce capsular redundancy if laxity persists. However, with arthroscopic extracapsular plication, the capsular tissue can be shortened without using thermal energy.     

Accuracy of atlantoaxial transarticular screw insertion

STUDY DESIGN: The accuracy and safety of atlantoaxial transarticular screw insertion were evaluated in clinical cases. OBJECTIVES: To evaluate the accuracy and safety of atlantoaxial transarticular screw insertion under lateral fluoroscopic monitoring without opening the joint. SUMMARY OF BACKGROUND DATA: Atlantoaxial transarticular screw fixation has been reported to be biomechanically superior to posterior atlantoaxial wiring techniques. Several clinical series have been reported in the literature. In some reports, the risk of screw insertion in this technique has been pointed out. MATERIALS AND METHODS: Fifty-six consecutive patients with atlantoaxial instability were treated by transarticular screw fixation. One hundred twelve screw insertions in these 56 patients were assessed by surgical record and computed tomographic examination. One screw could not be inserted because of the difficulty of adequate placement during operation; 111 screws were therefore inserted. Adequate position was defined as when the screw perforated the lateral atlantoaxial joint. RESULTS: In this series, neither vertebral artery injury nor spinal cord injury was experienced clinically. One guide wire was broken during drilling with a cannulated drill. Computed tomographic examination demonstrated that 106 screws perforated the atlantoaxial joint. Therefore, 95.5% of screws were adequately positioned. There were two screws positioned lateral to the joint, two medially, and one anteroinferiorly to the joint. CONCLUSIONS: Atlantoaxial transarticular screw insertion using image intensifier without opening the lateral joint was performed safely, but not accurately, in all cases.     

国产聚-DL-乳酸可吸收螺钉治疗松质骨骨折

目的探讨国产聚-DL-L乳酸(PDLLA)可吸收螺钉治疗松质骨骨折的效果及安全性，方法用PDLLA可吸收螺钉治疗松质骨骨折24例．随访观察术后骨折愈合、关节功能恢复情况和影像学表现。结果14例伤口均Ⅰ期愈合．全部病例随访6～25个月．平均12．3个月。6个月时X线片显示骨折线均已消失．获得骨性愈合；涉及关节面的骨折，术后关节功能均基本恢复正常。结论PDLLA可吸收螺钉是治疗松质骨骨折尤其是关节内骨折的理想内固定物。     

Accuracy of computer-guided screw fixation of the sacroiliac joint.

Computer-assisted image guidance allows precise preoperative planning and intraoperative localization of surgical instruments. The technique recently was validated for the insertion of pedicle screws. In the laboratory, the precision of a surface-matching algorithm was evaluated for registration and accuracy and safety of screw placement into the vertebral bodies of S1 and S2 for fixation of the sacroiliac joint. Using six plastic pelves, 24 screw holes were made through the sacroiliac joint into the vertebral body of S1, and 12 holes were made through the sacroiliac joint into S2. The accuracy of the hole position was evaluated using a postoperative computed tomography examination. The safety factor was assessed by analysis of the remaining bone stock around the holes calculating a theoretical cylindrical volume being outside bone with increasing bore hole diameters. The registration was accurate with a mean error less than 1.4 mm in the posterior parts of the pelvis. The drilling followed precisely the preoperatively planned trajectories; perforation of the cortex of the sacrum was not observed. The safety factor of the S1 vertebral body is higher than that of S2 allowing larger diameter screw insertion into S1. This technique provides a safe and precise guide for transcutaneous or open insertion of iliosacral screws in cases of iliosacral dislocation or sacral fracture.     

寰枢椎后路经关节螺钉固定术

目的评价参照枢椎椎管内壁行寰枢椎后路经关节螺钉固定（Naged技术）的可行性。方法2002年1月～2005年1月，对31例寰枢椎不稳患者行后路经关节螺钉内固定术，男18例，女13例；平均年龄36．8岁。螺钉置入方法：紧贴枢椎椎管内壁确定距离中线的距离，以枢椎椎板下缘上2帅为进针高度，两线交叉点即为螺钉进针点。螺钉平行矢状面，指向寰枢关节面后缘高度，通过C型臂机侧位像确认螺钉向上倾斜角度。术后结合正、侧位x线片、螺旋CT三维重建及断层扫描图像，评价螺钉置入准确程度。根据螺钉与寰枢椎关节面的位置关系分为A、B、C三区，A区螺钉通过寰椎下关节面；B区螺钉在关节面的前方或后方（前方为B1，后方为B2）；C区为螺钉在关节面的内侧或外侧（内侧为C1，外侧为C2）。结果共置入60枚螺钉。术中无椎动脉、颈脊髓、颈神经根及颅神经损伤。所有患者获得6～18个月（平均9个月）的随访，植骨融合时间为3～12个月，平均5个月，颈脊髓及神经根症状改善明显者3例，部分改善者5例，无改善者1例，无神经症状加重患者。枕颈部疼痛完全缓解者8例，部分缓解者6例，无缓解者2例。60枚螺钉中，A区58枚（96．7％），B1区2枚（3．3％），无B2及C区螺钉。结论参照枢椎椎管壁行寰枢椎后路经关节螺钉固定是安全可靠的。     

Osteosynthesis of a triplane fracture under arthroscopic control in a bilateral case

There are various types of ankle triplane fractures; they may be lateral and medial with two, three or four fragments. Some are described as extra-articular. We describe an exceptional bilateral case occurring after a trampoline accident of a displaced articular and an extra-articular fracture. The extra-articular fracture was treated by closed reduction and percutaneous fixation under fluoroscopic control. For the displaced articular fracture, an arthroscopically assisted reduction and percutaneous fixation was performed. The degree of rotation of the antero-lateral fragment of the articular triplane fracture, during percutaneous screw fixation, was not visible under image intensifier but could be corrected under arthroscopic control. Several portals can be made to enhance articular fracture reduction. This surgical procedure offers reliability and safety to the reduction and the synthesis of this articular fracture. It allows surgery to be less invasive in young patients, while decreasing the risk of malunion and poor long-term clinical results.     

Intraoperative fluoroscopy to evaluate fracture reduction and hardware placement during acetabular surgery.

OBJECTIVES: To evaluate use of intraoperative fluoroscopy during acetabular surgery to determine fracture reduction and accurate placement of screws. DESIGN: Retrospective. SETTING: Level I trauma center. PARTICIPANTS: Thirty patients with thirty-two acetabular fractures. INTERVENTION: Patients were evaluated with fluoroscopy during surgery to assess fracture reduction and screw placement. Anterior-posterior (AP), oblique, and lateral pelvic fluoroscopic images were obtained intraoperatively. Postoperative radiographs were used to verify fluoroscopic findings; computed tomography (CT) scans were used as the control to assess intraarticular screw placement. MAIN OUTCOME MEASUREMENTS: Radiographic and clinical assessment of fracture reduction and screw placement. RESULTS: Intraoperative fluoroscopy confirmed the extra-articular position of all screws evaluated. Postoperative CT scans confirmed the extra-articular placement of all screws assessed by fluoroscopy. Quality of reduction using intraoperative fluoroscopic images had a 100 percent correlation with reduction on final radiographs. One patient, with two screws placed without fluoroscopic evaluation, had intra-articular placement requiring revision surgery. CONCLUSIONS: Intraoperative fluoroscopy is effective in evaluating both acetabular fracture reduction and hardware placement.     

Talus- und Kalkaneusfrakturen

The treatment of displaced fractures of the talus and calcaneus is associated with a considerable learning curve. Malunion results in significant limitations of global foot function and painful posttraumatic arthritis. While early reduction of dislocations and fracture dislocations represent an emergency situation, the timing of definitive fixation has no measurable impact on the results and the incidence of avascular necrosis in central fractures of the talus. For internal fixation of displaced fractures with central comminution or medial joint impaction, anatomically shaped interlocking plates are available in addition to screws. The ideal treatment of displaced intra-articular calcaneal fractures is still controversial. Because of the variable fracture patterns and the vulnerable soft tissue cover, an individual treatment concept is advisable. In order to minimize the wound margin necrosis associated with extensile lateral approaches, selected fractures should be treated with less invasive fixation while controlling joint reduction via a sinus tarsi approach. Fixation in these cases is achieved with screws, intramedullary locking nails or modified plates that are inserted subcutaneously. Displaced extra-articular and simple intra-articular fractures can be reduced and fixed percutaneously. Functional aftertreatment aims at early rehabilitation independent of the kind of fixation. Peripheral fractures of the talus and calcaneus frequently result from subluxation and dislocation at the subtalar and Chopart's joints. They are still regularly overlooked and result in painful arthritis if left untreated. If an exact anatomical reduction of these intra-articular fractures is impossible, resection of small fragments is indicated.     

内窥镜辅助下前路经寰枢关节螺钉固定植骨融合术治疗上颈椎不稳

目的:探讨内窥镜辅助下前路经寰枢关节螺钉固定植骨融合术治疗上颈椎不稳的临床可行性及其疗效。方法:2006年1月至2009年12月采用内窥镜辅助下前路经寰枢关节螺钉固定植骨融合术治疗上颈椎不稳患者13例,男8例,女5例;年龄17~65岁,平均46.8岁。JeffersonⅡ型骨折6例,JeffersonⅢ型骨折1例,寰枢椎脱位3例,陈旧性齿状突骨折3例。患者均有枕颈部不适和活动受限,术前VAS评分为3.2～4.1分,平均3.8分;2例伴有不同程度脊髓功能损害者,按Frankel分级C级1例,D级1例。随访患者临床症状改善和植骨融合情况。结果:均在内镜辅助下顺利完成手术,13例患者共置入26枚螺钉;手术时间60～130min,平均80min;术中出血110~290ml,平均190ml。术中无脊髓、椎动脉损伤等并发症。术后复查CT显示1枚螺钉位置欠佳,螺钉外斜角偏小且上斜角偏大,螺钉部分进入椎管,但未损伤脊髓,未做处理;25枚位置良好。寰枢关节基本复位,固定可靠。术后随访12~60个月,平均18个月,末次随访时VAS评分降至1.0～2.0分,平均1.3分,与术前比较有统计学差异(P<0.05)。2例伴颈髓损伤患者的症状均有改善,Frankel分级C级者恢复到D级,D级者恢复到E级。12例患者术后3个月开始出现植骨融合,末次随访时寰枢关节间隙植骨均达到融合;1例患者未见明显植骨融合,但寰枢关节稳定性良好,未出现断钉等并发症。结论:内窥镜辅助下前路经寰枢关节螺钉固定植骨融合术治疗上颈椎不稳是可行的,能取得较好的治疗效果,且在一定程度上克服了传统手术显露困难的缺点,从而减少手术并发症。     

Complications of transpedicular screw fixation in the cervical spine

Today, posterior stabilization of the cervical spine is most frequently performed by lateral mass screws or spinous process wiring. These techniques do not always provide sufficient stability, and anterior fusion procedures are added secondarily. Recently, transpedicular screw fixation of the cervical spine has been introduced to provide a one-stage stable posterior fixation. The aim of the present prospective study is to examine if cervical pedicle screw fixation can be done by low risk and to identify potential risk factors associated with this technique. All patients stabilized by cervical transpedicular screw fixation between 1999 and 2002 were included. Cervical disorders included multisegmental degenerative instability with cervical myelopathy in 16 patients, segmental instability caused by rheumatoid arthritis in three, trauma in five and instability caused by infection in two patients. In most cases additional decompression of the spinal cord and bone graft placement were performed. Pre-operative and post-operative CT-scans (2-mm cuts) and plain X-rays served to determine changes in alignment and the position of the screws. Clinical outcome was assessed in all cases. Ninety-four cervical pedicle screws were implanted in 26 patients, most frequently at the C3 (26 screws) and C4 levels (19 screws). Radiologically 66 screws (70%) were placed correctly (maximal breach 1 mm) whereas 20 screws (21%) were misplaced with reduction of mechanical strength, slight narrowing of the vertebral artery canal (<25%) or the lateral recess without compression of neural structures. However, these misplacements were asymptomatic in all cases. Another eight screws (9%) had a critical breach. Four of them showed a narrowing of the vertebral artery canal of more then 25%, in all cases without vascular problems. Three screws passed through the intervertebral foramen, causing temporary paresis in one case and a new sensory loss in another. In the latter patient revision surgery was performed. The screw was loosened and had to be corrected. The only statistically significant risk factor was the level of surgery: all critical breaches were seen from C3 to C5. Percutaneous application of the screws reduced the risk for misplacement, although this finding was not statistically significant. There was also a remarkable learning curve. Instrumentation with cervical transpedicular screws results in very stable fixation. However, with the use of new techniques like percutaneous screw application or computerized image guidance there remains a risk for damaging nerve roots or the vertebral artery. This technique should be reserved for highly selected patients with clear indications and to highly experienced spine surgeons.     

Clinical application of C2 laminar screw technique

C2 laminar screws have become an increasingly used alternative method to C2 pedicle screw fixation. However, the outcome of this technique has not been thoroughly investigated. A total of 35 cases with upper cervical spinal instability undergoing C2 laminar screw fixation were reviewed. All cases had symptoms of atlantoaxial instability, such as craniocervical junction pain, and were fixed with the Vertex cervical internal fixation system. A total of 68 screws were placed and hybrid constructs (a C2 translaminar screw combined with a C2 pars screw) were incorporated in two patients. In this series, there were no intraoperative complications and no cases of neurological worsening or vascular injury from hardware placement. Computed tomographic scans demonstrated a partial dorsal laminar breach in ten patients. None of these resulted in neurological symptoms. None of the patients was found to have a breach of the ventral laminar cortex. All the C2 laminar screws fixations were performed successfully. There was no instability seen on the films with no evidence of hardware failure or screw loosening during the follow-up period in all patients. In conclusion, C2 laminar screw technique is straightforward and easily adopted; it can efficiently and reliably restore upper cervical stability. It is an alternative method to C2 pedicle screw fixation, especially in patients with unilateral occlusion of vertebral artery and pedicle deformity of C2.     

The invention of an iliosacral screw fixation guide and its preliminary clinical application

Objective: To introduce an iliosacral screw fixation guide and evaluate its efficacy in fixation of sacroiliac joint fracture‐dislocations. Methods: Between January 2011 and May 2011, eight patients (five men, three women) with sacroiliac joint fracture‐dislocation underwent percutaneous iliosacral screw fixation with the assistance of this minimally invasive guide and under CT guidance. The patients, aged from 26 to 56 years (mean 32 years), had vertically unstable pelvic fractures. Before surgery, six patients who had displacement of >2 cm in their sacroiliac joints underwent skeletal traction on the femoral condyle. The inserted sites were marked out on the affected side of their buttocks after the best screw trajectory had been determined under CT control. The gear that controls the direction of the minimally invasive guide was adjusted according to the inserting angle determined by CT scans. A K‐wire was inserted into the sacroiliac joint along the pilot sleeve of the guide, and a hollow screw (diameter 7.3 mm) was implanted into the sacroiliac joint along the K‐wire. Results: All eight operations were successful on the first attempt. The operations lasted from 10 to 20 minutes (mean 14 minutes). Immediate CT scans confirmed that all the screws had been placed in the desired positions, none had penetrated the bones and the configuration of the sacroiliac joints had been satisfactorily restored and firmly fixed. No patient experienced numbness or radiating pain in the lower limbs during surgery. There were no postoperative vascular or neurological complications. Conclusion: The minimally invasive guide can eliminate discrepancies resulting from the surgeon's own sensory input when inserting screws under the guidance of CT, making percutaneous iliosacral screw fixation more accurate, safe and simple.     

Arthroscopic assessment of intra-articular distal radius fractures after open reduction and internal fixation from a volar approach

PURPOSE: The volar approach with locked plating is a common treatment for intra-articular distal radius fractures. The purpose of this study was to arthroscopically assess the articular surface after internal fixation through the volar approach as a means to evaluate the ability of an extra-articular reduction to anatomically restore the joint surface. METHODS: Sixteen patients with intra-articular distal radius fractures were prospectively enrolled. A volar approach and internal fixation using a locked volar plate was performed. Using a visual analog scale (VAS), the fracture reduction was clinically graded on the quality of reduction of the visible metaphyseal fracture lines, fluoroscopically graded, and arthroscopic graded. Maximum step and gap deformity were recorded from arthroscopy and plain radiograph. RESULTS: The mean VAS score for the fracture reduction based on extra-articular fracture lines was 7.4. The mean VAS score for the fluoroscopic reduction was 8.2. The mean VAS score for the arthroscopic reduction was 6.4. The arthroscopic VAS score was significantly lower than the VAS score for fluoroscopy but was not significantly different than the VAS score for metaphyseal reduction. Mean arthroscopic measurement of maximum step and gap deformity were 1 mm and 2 mm, respectively. Mean postoperative radiographic maximum step and gap deformity were both less than 1 mm. The arthroscopic step and gap deformities were significantly greater than the radiographic deformities. CONCLUSIONS: A volar approach, indirect reduction, and locked plate fixation is a useful technique in restoring articular congruity after distal radius fracture. The number of fracture lines and presence of step and gap deformity can be adequately assessed using clinical and fluoroscopic assessment. However, the magnitude of step and gap deformity may be underestimated.