ARTHROSCOPIC TREATMENT OF INTRA-ARTICULAR FRACTURES OF THE SMALL JOINTS OF THE HAND

Abstract

747 INTRODUCTION: Several authors have documented an increase in arthritis withdisplaced articular fractures of the wrist. They advocated reduction of fractures with greater than of displacement (Jesse Jupiter). Recently, others have documented the efficacy of arthroscopic assisted reduction of wrist fractures (Wolfe) and displaced ligament tears of the center lesion (West Virginia). PURPOSE: Our purpose was to evaluate the efficacy of small joint arthroscopy in the assisted reduction of intra-articular fractures of the metacarpophalangeal joint. MATERIALS AND METHODS: A retrospective review of the records from 1991-1996 at Yale New Haven Hospital identified eighteen cases of displaced intra-articular fractures involving the metacarpophalangeal joint which were operatively treated. seven patients had arthroscopic assisted reductions and the remaining eleven had standard AO fixation. Radiographs, office notes and physical therapy records were reviewed, statistical analysis of data was with a student T-test. RESULTS: Eighteen patients, seventeen male and one female were identified. The average age was twenty-nine with a range of fourteen to fifty-eight. All fractures presented as closed injuries. Digits involved included the thumb, index, long, ring and little fingers. The etiologies included sports, work, and motor-vehicle accidents. For the purpose of analysis the fractures were divided into two groups. Group I was arthroscopic assisted fracture reduction, Group II was standard AO repair. Group I had seven patients, Group II had eleven. Group I, the average follow-up was 6 months, for Group II it was 13 months. Group I started physical therapy one week post op, averaging five treatments with a final range of motion for the mcp joint of 81+-13 and PIP 99+-9. This compared to Group II which started physical therapy at two weeks, averaging thirteen treatments with a final range of motion for the MCP 61+-17=83 and pip 68+-22. these difference were significant(P<.05). operating time and complications were minimal with no significant difference. SUMMARY: This small study suggests that arthroscopic reduction of fractures allows for earlier initiation of rehabilitation less total number of therapy visits and significant improved range of motion. Plans are now for a prospective randomized study to evaluate the efficacy of this method.