Operative Treatment of Intra-Articular Distal Radius Fractures With Versus Without Arthroscopy: A Randomized Controlled Trial RADAR-trial

Abstract

There is no financial information to disclose. The past several years, an increase in open reduction internal fixation (ORIF) for intra-articular distal radius fractures has been observed. This technique leads to a quicker recovery of function compared with nonsurgical treatment. However, some patients continue to have a painful and stiff wrist postoperatively. Arthroscopically assisted removal of intra-articular fracture hematoma and debris may improve the functional outcomes following operative treatment of intra-articular distal radius fractures. The purpose of this randomized controlled trial is to determine the difference in functional outcome, assessed with the Patient-Rated Wrist Evaluation (PRWE) score, after ORIF with and without an additional wrist arthroscopy in adult patients with displaced complete articular distal radius fractures. In this multicenter trial, adult patients with a displaced complete articular distal radius fracture were randomized between ORIF with an additional wrist arthroscopy to remove fracture hematoma and debris (intervention group) and conventional fluoroscopic assisted ORIF (control group). The primary outcome was functional outcome assessed with the PRWE score after 3 months. Secondary outcomes were wrist function assessed with the Disability of the Arm, Shoulder and Hand (DASH) score, postoperative pain, range of motion, grip strength, complications, and cost-effectiveness. Additionally, in the intervention group the quality of reduction, associated ligamentous injuries and cartilage damage were assessed. A total of 50 patients were included in this study. A total of 50 patients were randomized, 25 to the intervention group and 25 to the control group. All patients who had arthroscopic treatment had a hematoma, which was removed. Other arthroscopic findings were: TFCC injury in 91%, scapholunate injury in 50%, lunotriquetral injury in 50%, damage of the fossa lunata in 68%, and damage of the fossa schapoidea in 55%. Mean PRWE was not significantly better for the intervention group at 3 weeks (49 [28–66] vs 59 [49–66], P = .08), and at 6 weeks (41 [20–58] vs 38 [29–45], P = .61). Mean PRWE was significantly worse for the intervention group at 3 months (30 [8.2–46] vs 14 [5–21], P = .01). •Patients treated with additional arthroscopy to remove hematoma and debris do not have better functional outcomes compared with the non–arthroscopically treated group.