Apport de l’arthroscopie en complément de l’ostéosynthèse des fractures articulaires de l’extrémité distale du radius. Étude prospective à propos de 40 cas

Abstract

The purpose of our study was to compare the treatment of intra-articular distal radius fracture with locking volar plates with and without arthroscopy. We compared short-term clinical and functional recovery between the two groups. This was a retrospective, single-center study of intra-articular fractures. A volar locked plate was used for fracture fixation in all patients. Twenty patients were operated with fluoroscopy only- “plate” group and 20 operated using arthroscopy assistance “arthroscopy” group. All patients underwent a CT scan before surgery and at 3 months postoperative. The main outcome measure was the residual intra-articular step-off (measured in millimeters). Other outcomes were the residual gap between fragments, extra-articular reduction and functional and clinical recovery. The two groups were similar preoperatively in all aspects except the gap between fragments. The residual step-off was significantly less in the arthroscopy group- 1.9 mm (Q1 1.7 + Q3 2.25) for plate versus 0.8 mm (Q1 0.7 + Q3 1.5) for arthroscopy (P = 0.001). The change from the preoperative to the postoperative measurement was significantly greater in the arthroscopy group- 0.1amm (0.5 + Q3 0.8) for plate and ±1 mm (Q1 ±1.9 + Q3 -0.6) for arthroscopy (P = 0.0002). The residual gap was similar between both groups- 2.4 mm (Q1 1.9 + Q3 3.5) for plate versus 2.3 mm (Q1 1.1 + Q3 2.8) for arthroscopy (P = 0.37). The change in gap was not significantly different between the two groups- ± 0.9 mm (Q1 ± 1.8 + Q3 ± 0.1) for plate versus ± 2.9 mm (Q1 -4.4 + Q3 ± 1.7) for arthroscopy (P = 0.32). There was no difference in the extra-articular reduction. Damage was found to the scapholunate ligament in 30% and the TFCC in 30% of arthroscopy cases. Arthroscopy improves intra-articular reduction without altering extra-articular reduction in patients with intra-articular fractures of the distal radius and it allows for assessment and treatment of any injuries discovered.