Abstract
BackgroundIn the past several years, an increase in open reduction and internal fixation (ORIF) for intra-articular distal radius fractures has been observed. This technique leads to a quicker recovery of function compared to non-operative treatment. However, some patients continue to have a painful and stiff wrist postoperatively. Arthroscopically assisted removal of intra-articular fracture haematoma and debris may improve the functional outcomes following operative treatment of intra-articular distal radius fractures. The purpose of this randomised 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.MethodsIn this multicentre trial, adult patients with a displaced complete articular distal radius fracture are randomised between ORIF with an additional wrist arthroscopy to remove fracture haematoma and debris (intervention group) and conventional fluoroscopic-assisted ORIF (control group). The primary outcome is functional outcome assessed with the PRWE score after three months. Secondary outcomes are 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 will be assessed. A total of 50 patients will be included in this study.DiscussionAlthough ORIF of intra-articular distal radius fractures leads to a quicker resume of function compared to non-operative treatment, some patients continue to have a painful and stiff wrist postoperatively. We hypothesise that, due to the removal of fracture haematoma and debris by an additional arthroscopy, functional outcomes will be better compared to the non-arthroscopically treated group.Trial registrationClinicalTrials.gov, NCT02660515. Registered on 13 January 2016.
Highlights
In the past several years, an increase in open reduction and internal fixation (ORIF) for intra-articular distal radius fractures has been observed
Intra-articular distal radius fractures, which comprise almost 50% of all fractures [4], are increasingly being treated operatively. This technique leads to a quicker resume of function in the first three to six months compared to non-operative treatment [5, 6]
The mean Patient-Rated Wrist Evaluation (PRWE) score after a distal radius fracture after three months of follow-up in adult patients is 28 with a standard deviation of 21.3 [36]. This PRWE score was measured in a population in which 38% of patients suffered from a complete articular distal radius fracture (AO/OTA type C fracture)
Summary
In the past several years, an increase in open reduction and internal fixation (ORIF) for intra-articular distal radius fractures has been observed This technique leads to a quicker recovery of function compared to non-operative treatment. Intra-articular distal radius fractures, which comprise almost 50% of all fractures [4], are increasingly being treated operatively This technique leads to a quicker resume of function in the first three to six months compared to non-operative treatment [5, 6]. Assisted removal of intra-articular fracture haematoma and debris may improve the functional outcomes following operative treatment of intra-articular distal radius fractures [7, 8]. During arthroscopy the quality of the reduction [7, 9, 10] and the presence of associated ligamentous injuries can be assessed [11,12,13,14]
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