Abstract
Purpose: Arthroscopy of the wrist can be an alternative to open surgery for joint fractures of the radius by checking reduction of often impacted fragments and analysing associated injuries.
Material: Twenty-eight patients (15 men and 13 women) were treated arthroscopically. Mean age was 51 years (range 19–82). There were four fractures of the styloid process of the radius, six posteromedial fractures, eleven 3-fragment T fractures and seven fractures with four or more fragments. There were 19 associated injuries (six lesions of the triangular ligament, four lesions of the luno-triquetral ligament, and nine lesions of the scapho-lunate ligament including four requiring pinning.
Methods: Loco-regional anaesthesia was used for all patients. The elbow was flexed at 90° and the wrist placed under axial traction using a “Japanese” device. After careful cleaning of the joint, reduction was achieved by pinning under arthroscopic and fluoro-scopic guidance. In certain very unstable cases (i.e. the fractures with four or more fragments), additional plate fixation was required. An external prosthesis was worn for 45 days.
Results: Mean follow-up was 21 months (6–36 months). Wrist movement was normal in 24 patients and pain had totally resolved for 27. There were no secondary displacements requiring surgical revision. Horizontalisation of the radius was observed in two cases and inversion of the lower radio-ulnar index (about 0.5 cm) in four. The functional outcome was excellent or good in 22 patients, fair in five, and poor in one due to reflex dystrophy.
Discussion: The indication for surgical treatment of joint fractures is now well recognised. Our results are comparable to those in other series where arthroscopic management has been used for this type of fracture. The quality of the functional results appears to be directly related to the quality of the reduction and fixation achieved under traction.
Conclusion: Arthroscopic management of joint fractures of the lower quarter of the radius enables anatomic reduction necessary for good functional outcome.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
