Arthroscopic assisted treatment of distal radius fractures and concomitant injuries

Tobias Kastenberger,Peter Kaiser,Gernot Schmidle,Peter Schwendinger,Rohit Arora,Markus Gabl

doi:10.1007/s00402-020-03373-y

Abstract

Wrist arthroscopy is mainly used to assist fracture reduction and fixation and to diagnose and treat concomitant injuries mainly to the scapholunate (SL), lunotriquetral (LT) ligament and the triangular fibrocartilage complex (TFCC). Arthroscopy is beneficial in improving anatomical reduction of fracture steps and gaps in intra-articular distal radius fractures (DRFs). Yet, the literature that the functional outcome correlates with the use of arthroscopy, is limited. Non-surgical treatment and immobilization is recommended for Geissler grade I–III Sl-ligament injuries, while open reduction, ligament suture and/or K-wire pinning is mandatory for complete ligament tears according to Geissler grade IV. This manuscript describes the current literature and gives insight into the authors’ opinions and practice.

Highlights

Distal radius fractures (DRFs) belong to the most common fracture type in humans
Depending on fracture fragment dislocation, fracture instability criteria, the patient’s needs, and functional demands, treatment can vary between non-surgical treatment with cast immobilization and surgical treatment with open reduction and internal fixation
Simple diagnostic wrist arthroscopy and soft tissue procedures can be performed under wide awake local anesthesia and no tourniquet (WALANT) surgery [21], patients with intra-articular DRFs are usually treated under general or regional anesthesia, in case of the need for manipulation of fracture fragments, which might be painful [19]

Summary

Introduction

Distal radius fractures (DRFs) belong to the most common fracture type in humans. Depending on fracture fragment dislocation, fracture instability criteria, the patient’s needs, and functional demands, treatment can vary between non-surgical treatment with cast immobilization and surgical treatment with open reduction and internal fixation. Simple diagnostic wrist arthroscopy and soft tissue procedures can be performed under wide awake local anesthesia and no tourniquet (WALANT) surgery [21], patients with intra-articular DRFs are usually treated under general or regional anesthesia, in case of the need for manipulation of fracture fragments, which might be painful [19]. Acute grade IV injuries show a dynamic instability and need surgical treatment using arthroscopic or open reduction and K-wire pinning and/or anchor fixation [10]. There are no long-term studies investigating the impact of cast fixation in partial injuries It is questionable if the improved diagnosis using arthroscopy, and the resulting treatment of lower graded injuries leads to a better functional outcome. Other complications include a loss of reduction, loosening of a K-wire, pin infections, complex regional pain

Conclusion

Findings

Compliance with ethical standards