Dry Arthroscopy of the Wrist: Its Role in the Management of Articular Distal Radius Fractures

Abstract

Most arthroscopies in the body are carried out infusing water to create an optical working cavity. Under those conditions we found the management of distal radius fractures quite cumbersome, not to say that compartment syndrome risk did exist (11). Furthermore, when we used to use water to distend the joint, performing semi-open operations such as osteotomies, or distal radio-ulnar joint reconstructions, were impracticable. Extrapolating that in other “scopies” in the human body, such as laparoscopy or thoracoscopy, water was not used to maintain the optic cavity, we realized that traction through the fingers was sufficient to maintain the wrist open. Main advantages were that soft tissue extravasation was eliminated, much facilitating any combined open surgery as the tissues maintained their original properties. The dry technique, which in essence is similar to the classic technique but without infusing water, introduces a new set of difficulties derived from vision loss secondary to splashes of blood or soft-tissue debris that may stick to the scope tip. Removing the scope and wiping off the lens with a wet sponge is efficacious but time consuming. Moreover, poor vision quality or being immersed in a “red sea” may make the surgeon abandon this technique that has a lot to offer. This is particularly true for distal radius fractures. Based on our experience with more than 300 dry wrist arthroscopies we have found the following technical tips helpful: