In a randomised prospective study, 20 patients with intra-articular fractures of the distal radius underwent arthroscopically- and fluoroscopically-assisted reduction and external fixation plus percutaneous pinning. Another group of 20 patients with the same fracture characteristics underwent fluoroscopically-assisted reduction alone and external fixation plus percutaneous pinning. The patients were evaluated clinically and radiologically at follow-up of 24 months. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and modified Mayo wrist score were used at 3, 9, 12 and 24 months postoperatively. In the arthroscopically- and fluoroscopically-assisted group, triangular fibrocartilage complex tears were found in 12 patients (60%), complete or incomplete scapholunate ligament tears in nine (45%), and lunotriquetral ligament tears in four (20%). They were treated either arthroscopically or by open operation. Patients who underwent arthroscopically- and fluoroscopically-assisted treatment had significantly better supination, extension and flexion at all time points than those who had fluoroscopically-assisted surgery. The mean DASH scores were similar for both groups at 24 months, whereas the difference in the mean modified Mayo wrist scores remained statistically significant. Although the groups are small, it is clear that the addition of arthroscopy to the fluoroscopically-assisted treatment of intra-articular distal radius fractures improves the outcome. Better treatment of associated intra-articular injuries might also have been a reason for the improved outcome

Aim. To evaluate the correlation between the clinical Kirk Watson test and arthroscopic Geissler classification in scapholunate instability. Methods. All patients undergoing wrist arthroscopy between April 2006 and April 2010 were evaluated. Patients were included in the study if they had a Kirk Watson test and a wrist arthroscopy with an assessment of the stability of the scapholunate joint using the Geissler classification. Patients who had a Kirk Watson test performed with subsequent normal scapholunate joint at arthroscopy were included as a control group. Geissler grades 1 and 2 and grades 3 and 4 were grouped for further analysis into low and high grade instability groups respectively. Results. 76 patients were included in the study. 62 had scapholunate pathology and 14 had normal arthroscopic examinations of the stability of the joint. A positive test was found in 30% (3) of patients with grade 1 instability, 29% (4) with grade 2, 60% (12) with grade 3 and 78% (14) with grade 4 instability demonstrated at arthroscopy. The test was positive more commonly in those with grade IV instability compared with others (78% vs. 43%; p=0.015). There was a higher number with a negative test in the low grade instability group (71% vs. 32%; p=0.01) and a higher number with a positive test in the high grade instability group (68% vs. 29%; p=0.006). The test was most sensitive (78%) and most specific (57%) for those classified with Geissler grade IV instability and sensitivity and specificity were also high for those with high grade instability (68% and 66% respectively). Conclusions. The Kirk Watson test is a sensitive and specific test for diagnosis of higher grade instability of the scapholunate joint. We found a positive correlation between increasing scapholunate instability when assessed using the Geissler classification and positivity of the test. This confirms that the Kirk Watson test can be a useful test in the assessment of those with symptomatic instability of the joint and may reflect damage not only to the scapholunate ligament but to the secondary stabilisers of the joint as well

A total of 118 consecutive patients with a fracture of the distal radius were treated with a volar locking plate; 50 patients had no ulnar styloid fracture, 41 had a basal ulnar styloid fracture, and 27 had a fracture of the tip of the ulnar styloid. There were no significant differences in radiological and clinical results among the three groups. The outcome was good and was independent of the presence of a fracture of the ulnar styloid. A total of five patients (4.2%) had persistent ulnar-sided wrist pain at final follow-up. Nonunion of the ulnar styloid fracture did not necessarily lead to ulnar wrist pain. Patients with persistent ulnar pain had a higher mean initial ulnar variance and increased post-operative loss of ulnar variance.

The presence of an associated ulnar styloid fracture of the ulnar styloid does not adversely affect the outcome in patients with a fracture of the distal radius treated by volar plating.