Wrist arthroscopy in extra-articular distal radius fractures: Extra-articular fractures are articular trauma, a prospective series of 35 cases

Abstract

Introduction In articular distal radius fractures, arthroscopy has demonstrated benefits to diagnose and treat ligament injuries of the wrist, in particular for the triangular fibrocartilage complex (TFCC). For extra-articular radius fractures, this prospective series proposes to assess ligament injuries (especially TFCC) with a systematic wrist arthroscopy. Indeed, the two forearm bones work as a functional unit and the fracture of one bone often induces a fracture of the second one. When the fracture of the second bone does not occur, we can suspect a dissociative ligamentous injury between the 2 bones, especially a TFCC injury. This hypothesis was oriented by our recent series concerning TFCC injuries in Galeazzi fractures. Materials and methods Over a period of one year, 35 extra-articular distal radius fractures were operated on with systematic radiocarpal arthroscopy. Selected patients were younger than 65 years with recent closed surgical extra-articular radius fractures associated or not with an ulnar fracture. We used a locking anatomical compression plate, a 1.9 mm arthroscope with 3 systematic radio-carpal portals: volar radiocarpal, 3-4, 4-5 and an extra 6U portal for TFCC repair. A splint was kept for 3 weeks followed by an active/passive physiotherapy. Physical examination and X-ray were performed after 3, 6 and 12 weeks. Analysis criteria were: – perioperative: ligament injuries, duration of surgery; – postoperative: pain, wrist motion (F/E°; P/S°), grasp strength, time off work and sports, X-ray analysis (reduction, consolidation, secondary displacement). Results Five patients were only reviewed twice. The TFCC was injured in 21 cases: – with ulnar fractures (n = 20): 8 injuries including 6 radial lesions; – without ulnar fracture (n = 15): 13 injuries including 9 ulnar lesions. One radial TFCC injury and all ulnar lesions were repaired. About strength and motion: – after 3 weeks: F/E: 60/55°, P/S 60°/70°, grasp 23%; – after 6 weeks: F/E: 75/70°, P/S 75°/80°, grasp 52%; – after 12 weeks: F/E: 85/80°, P/S 80°/80°, grasp 88%. We noticed 30 anatomic reductions and none secondary displacement. Time off work was 4 weeks (0–7). Discussion and conclusion Extra-articular radius fractures without ulnar fracture were often associated with TFCC injuries, rather ulnar. Both bone fractures were less associated with TFCC injuries, rather radial. This study is a first step demonstrating a diagnosis interest in systematic wrist arthroscopy for extra-articular radius fractures. In order to demonstrate a prognosis interest in rapidity and quality of recovery, a further comparative study with prono-supination strength and power measurement should be necessary.