Francisco del Piñal, MD, PhD, Melissa Klausmeyer, MD, Eduardo Moraleda, MD, Guillermo H. de Piero, MD, Jaime S. Rúas, MD

Journal of Hand Surgery American Edition Vol. 39, Issue 5, May 2014, Pages 835-843 © 2014 by the American Society for Surgery of the Hand – All rights reserved.

ABSTRACT (full text pdf. below)

Arthroscopic Reduction of Comminuted Intra-Articular Distal Radius Fractures With Diaphyseal-Metaphyseal Comminution

Purpose In the setting of severely comminuted diaphyseal-metaphyseal fractures of the distal radius, arthroscopic reduction of the joint surface is difficult and often results in shortening and collapse. Yet, several authors have shown the benefits of arthroscopy in articular distal radius fractures. We present a method that safely allows a combination of arthroscopic reduction and rigid fixation and describe the outcomes in a small group of patients.

Methods Four consecutive patients with severely comminuted diaphyseal-metaphyseal articular fractures of the distal radius were treated using the stable reference fragment technique. For all cases, we used an extra-long volar locking plate applied to the diaphysis of the radius. Preoperative computed tomography scanning was used to identify the largest articular fragment. This reference fragment was reduced and stabilized with locking pegs or screws to the volar plate under fluoroscopic guidance. The articular reduction continued arthroscopically, using the reference fragment as a guide. Once the articular reduction was complete, the comminuted metaphysis was addressed and secured to the plate.

Results All patients achieved excellent clinical and radiological results. Flexion-extension averaged 124º and pronation-supination averaged 174º. One patient showed minor signs of radiocarpal osteoarthritis on radiographs at 3 years.

Conclusions By securing the reference fragment before addressing the metaphyseal comminution, a stable platform was created. Thus, intra-articular reduction was achieved while maintaining extra-articular alignment. Although the results were excellent, the number of cases was small.

Type of study/level of evidence Therapeutic IV.

Key words: Arthroscopy, wrist, articular distal radius, comminuted fractures.