Arthroscopically assisted osteosynthesis of complex intra-articular fractures of the distal radius

BACKGROUND: Complex intra-articular fractures of the distal radius pose a great challenge in orthopedic surgery. Conventional open reduction and internal fixation generally yields poor functional outcome. The technique of arthroscope-assisted surgery allows more accurate reduction of the articular surface and treatment of soft tissue lesions, both of which are necessary for regaining anatomic structure and satisfactory function. METHODS: Twenty wrists in 18 patients with intra-articular fracture of the distal radius received arthroscopic surgery and percutaneous pinning with or without external skeletal fixation and bone grafting. A new traction method was designed that allows arthroscopic surgery and fluoroscopic monitoring to be performed simultaneously. Postoperative follow-up averaged 24.7 months. RESULTS: All except one of these patients returned to work within 3 to 6 months after surgery. Later collapse with minimal articular step-off was noted on radiographs before osseous union in two patients who did not undergo bone grafting. Decreased radial height because of subsequent displacement at the metaphyseal fracture was noted in one patient who did not receive external skeletal fixation initially. CONCLUSION: The technique of arthroscope-assisted surgery, despite a steep learning curve, is an invaluable method. Results using this technique are promising and few complications are encountered in the treatment of complex radius platform fractures. The bone grafting procedure augments osseous union, shortens the duration of external skeletal fixation, and thus lessens joint stiffness.