Limited Open Reduction Research Articles

Treatment of Intra-articular Fractures of the Distal Radius using Wrist Arthroscopy

Purpose: The purpose of this study was to investigate the usefulness of wrist arthroscopy for treating intra-articular fractures of the distal radius. Materials and Methods: Twenty-two patients with intra-articular fracture of the distal radius received arthroscopic surgery. Fourteen patients with displaced intra-articular fractures were managed by arthroscopically assisted reduction and fixation. Three patients were treated with limited open reduction and fixation. We analysed the radiologic results, and measured the ranges of motion and grip strengths. Fuctional results were evaluated using the Modified Mayo Wrist Scoring System. The postoperative follow-up period averaged 16.8 months. Results: All showed articular step-off of less than 1 mm on wrist X-rays taken at the final follow-up (mean 0.3 mm; range, 0-1 mm). The mean arc of range of motion was 89.6% of that on the uninjured side, and the mean grip strength was 87.3% of that of the uninjured side. The average Modified Wrist Score was 91.8 (range, 75-100). Conclusion: Arthroscopic-assisted surgery is an useful method that provides excellent results with few complications in the treatment of intra-articular fractures of the distal radius.

The Damage Control Orthopedic (DCO) Footplate: A New Use of the Hoffmann II External Fixation System

Recent literature supports the provisional fixation of fractures in polytraumatized patients with delayed limited open reduction and internal fixation when the soft tissue envelope and patient's medical condition permits [10] [11]. For fractures of the tibial pilon many external fixation systems use a footplate with thin wires originally designed for reconstruction and deformity correction to span the ankle joint [4] [5] [6] [7]. Others use a single point of fixation in the calcaneus (“A frame”) to provide initial stabilization of the lower extremity. However, control of the midfoot and forefoot with a footplate controls the reduction in deformity of pilon fractures and prevents equinus deformity. A footplate also provides a method to hold the heel off the bed preventing pressure ulcers in polytrauma patients. The small wire footplate is technically demanding and has limited degrees of freedom when positioned for attachment to a ring around the distal tibial fracture. A mid and forefoot controlling system can be made using the Hoffmann II compact system and an arch bar (Fig. [1]). The newly designed Hoffmann II footplate maintains the reduction of the plafond fracture and raises the foot off the bed. The footplate uses existing Hoffmann II components and retains its flexibility and modularity.

Limited open reduction and Ilizarov external fixation in the treatment of distal tibial fractures

The authors reviewed 31 distal tibial fractures (16 involving the tibial plafond) treated with Ilizarov external fixation. The study population was composed of 19 males and 12 females, with an average age of 54. The fractures were classified according to the AO classification: A1 (3), A2 (6), A3 (6), C1 (2), C2 (8), C3 (6). There were six open injuries. In 14 pilon cases, open reduction of the intra-articular fragments and bone grafting via a limited incision was performed. Clinical follow-up averaged 28 months (range 18–42). All but one fracture united with an average healing time of 13.9 weeks. Nearly all patients with AO type A fracture had excellent or good functional scores. The 14 cases of AO C2 and C3 group had five (38%) good results, five (38%) fair results and three (24%) poor results. This method yielded results comparable with previous studies using open reduction and internal fixation. Twenty-nine percent of the patients had pin track infection, which remained the most important complication of this method.

Displaced acetabular fractures managed operatively: indicators of outcome.

This study examined retrospectively the clinical and radiographic features of acute displaced acetabular fractures which heavily influence the quality of an open reduction and clinical outcome. Of 424 acute fractures (119 simple and 305 associated injuries) in 411 patients, the mean time from the injury to surgery was 8.2 days (range, 0-21 days). The mean age of the patients was 46.5 years (range, 13-89 years), and followup was an average of 9.3 years (range, 3-21 years). For the 424 hips, the reduction was anatomic in 282 (67%), imperfect in 90 (21%), poor in 39 (9%), and secondarily congruent in 13 both-column fractures (3%). The quality of the reductions markedly deteriorated with advancing age. Clinically, the Harris hip score was excellent in 179 (42%), good in 126 (30%), fair in 54 (13%), and poor in 65 (15%). Excellent or good clinical outcomes were recorded in 249 of 282 patients (89%) with an anatomic reduction. Of the 119 patients with fair and poor results, 92 patients (77%) had complicating factors recognizable at clinical presentation, including extensive impaction, articular abrasion, a femoral head or neck fracture, or endogenous obesity. Although stable anatomic reduction of most displaced acetabular fractures affords the optimal prognosis, especially in younger patients, the initial clinical and radiologic evaluations delineate a sizable minority with poorly prognostic features that favor a poor clinical outcome after internal fixation, by minimizing the likelihood for an anatomic reduction or compromising the outcome despite an anatomic reduction. With the rapidly aging population accentuating this trend, a reappraisal for the role of the current therapeutic alternatives of nonoperative treatment, a limited open reduction, or an acute total hip replacement merits review.

Closed reduction and percutaneous fixation of anterior column acetabular fractures.

The current standard treatment of anterior column acetabular fractures includes formal open reduction with internal fixation (ORIF) through a variety of anterior approaches. These approaches have been associated with significant blood loss, infection, lengthy operative times, and neurovascular complications. It therefore seems reasonable to consider less invasive alternatives to conventional treatment methods. A technique for percutaneous reduction and fixation of a particular acetabular fracture pattern is presented. Execution of this technique has been facilitated by the use of image-guided surgical navigation. A retrospective review was performed on 23 patients who had suffered an acute anterior column fracture of the acetabulum (OTA 62-A3.2, 62-A3.3, 62-B3.2, 62-B3.3) managed with closed reduction and internal fixation using large-bore cannulated screws over an 11-year period. An additional three patients treated during the study period underwent formal ORIF with plates and screws after failure of attempted closed reduction, and were not included in this analysis. Eight of the 23 patients had an associated posterior hemitransverse fracture that was also managed with minimally invasive fixation. A variety of surgical navigation techniques were used to allow accurate percutaneous screw placement: CT-guided percutaneous fixation was performed in 10 patients (1990-1995); fluoroscopy alone was used in four patients (1995-1998); and computer-assisted virtual fluoroscopy was used in nine patients (1999-2002). Some fractures were nondisplaced but potentially unstable, and involved the superior weight-bearing dome; others required closed manipulation using Schanz-pin joysticks placed into the iliac wings and held in place with a temporary external fixator. One patient required a limited open reduction followed by percutaneous screw fixation. After confirmation of adequate reduction, one to three large-bore cannulated screws were placed percutaneously using previously defined safe trajectories. All patients were managed postoperatively with early mobilization and physical therapy. The average preoperative and postoperative displacements were 8.9 and 2.4 mm, respectively. No patient had a loss of reduction during healing. As experience was gained with the computer-assisted imaging, total fluoroscopy times were as little as 6 s, and were routinely kept below 45 s. None of the patients experienced infection, significant blood loss, or iatrogenic neurologic or visceral injury. No symptomatic heterotopic ossification was noted. Of those patients available for follow-up at a minimum of 2 years, the average HSS self-administered hip score was 91. We believe that our findings substantiate percutaneous reduction and internal fixation of anterior column acetabular fractures as a safe and effective alternative to formal ORIF, with a low anticipated complication rate and excellent outcome.

Closed Reduction and Percutaneous Fixation of Anterior Column Acetabular Fractures

Objective: The current standard treatment of anterior column acetabular fractures includes formal open reduction with internal fixation (ORIF) through a variety of anterior approaches. These approaches have been associated with significant blood loss, infection, lengthy operative times, and neurovascular complications. It therefore seems reasonable to consider less invasive alternatives to conventional treatment methods. A technique for percutaneous reduction and fixation of a particular acetabular fracture pattern is presented. Execution of this technique has been facilitated by the use of image-guided surgical navigation.Materials and Methods: A retrospective review was performed on 23 patients who had suffered an acute anterior column fracture of the acetabulum (OTA 62-A3.2, 62-A3.3, 62-B3.2, 62-B3.3) managed with closed reduction and internal fixation using large-bore cannulated screws over an 11-year period. An additional three patients treated during the study period underwent formal ORIF with plates and screws after failure of attempted closed reduction, and were not included in this analysis. Eight of the 23 patients had an associated posterior hemitransverse fracture that was also managed with minimally invasive fixation. A variety of surgical navigation techniques were used to allow accurate percutaneous screw placement: CT-guided percutaneous fixation was performed in 10 patients (1990-1995); fluoroscopy alone was used in four patients (1995-1998); and computer-assisted virtual fluoroscopy was used in nine patients (1999-2002). Some fractures were nondisplaced but potentially unstable, and involved the superior weight-bearing dome; others required closed manipulation using Schanz-pin joysticks placed into the iliac wings and held in place with a temporary external fixator. One patient required a limited open reduction followed by percutaneous screw fixation. After confirmation of adequate reduction, one to three large-bore cannulated screws were placed percutaneously using previously defined safe trajectories. All patients were managed postoperatively with early mobilization and physical therapy.Results: The average preoperative and postoperative displacements were 8.9 and 2.4 mm, respectively. No patient had a loss of reduction during healing. As experience was gained with the computer-assisted imaging, total fluoroscopy times were as little as 6 s, and were routinely kept below 45 s. None of the patients experienced infection, significant blood loss, or iatrogenic neurologic or visceral injury. No symptomatic heterotopic ossification was noted. Of those patients available for follow-up at a minimum of 2 years, the average HSS self-administered hip score was 91.Conclusion: We believe that our findings substantiate percutaneous reduction and internal fixation of anterior column acetabular fractures as a safe and effective alternative to formal ORIF, with a low anticipated complication rate and excellent outcome.

Technical aspects of limited open reduction and percutaneous screw fixation of fractures of the acetabulum

This article describes a technique for closed or limited open reduction and percutaneous screw fixation of acetabular fractures, indications and rationale for surgery, as well as fluoroscopic imaging techniques and screw pathways. In addition, complications found with the technique are also discussed.

Preliminary results and complications following limited open reduction and percutaneous screw fixation of displaced fractures of the actabulum

Twenty-four patients underwent attempted closed or limited open reduction of displaced acetabular fractures. If reduction was successful, the fractures were stabilized with percutaneous screws. Group 1 was composed of elderly patients with complex fractures and radiographic findings that were felt to be predictive of post-traumatic arthritis. In these patients, percutaneous screw fixation was used to improve fracture anatomy, allow mobilization and total hip replacement later, if necessary. In group 1, anatomical reduction was not felt to be a necessity. Group 2 was composed of young patients with simple fracture types. For group 2, anatomical reduction was the goal. In 23/24 patients, closed or limited open reduction was successful. In group 1, maximum displacement averaged 10 mm preoperatively, 3 mm postoperatively. In group 2, maximum displacement averaged 7 mm preoperatively, 1 mm postoperatively. One elderly patient was lost to follow-up and one died, leaving 21 patients with an average follow-up of 12 months. All the fractures healed. One patient had a transient femoral nerve palsy, and two elderly patients had minor losses of reduction due to unprotected ambulation after surgery. Five of the elderly patients have gone on to total hip arthroplasty. The average Harris Hip scores in groups 1 and 2 were 85 and 96, respectively.

The treatment of tibial plafond fractures with external fixation: closed or limited open reduction technique

Objectives: To evaluate the results of treatment for tibial plafond fractures with the use of external fixation with closed or limited open reduction. Methods: Twenty-two fractures of 21 patients (14 males, 7 females; mean age 28.2 years; range 19 to 52 years) were evaluated. According to the Ruedi and Allgower classification, the types of fractures were I, II, and III in four, four, and 14 patients, respectively. Four patients had grade I, four had grade II, and five had grade III open fractures. The tibial joint surface restoration was made by limited open reduction and minimal osteosynthesis (n=7); and fibular restoration with tubular plates (n=4), and Rush pins (n=6). The fixators were circular (n=8), monolateral (n=10), and hybrid (n=4). Primary otogeneous bone grafting was performed in four cases with metaphyseal bone defect, and skin grafting for soft tissue coverage in two cases. The results were evaluated according to the Teeny criteria. The mean duration for external fixation was nine weeks (6 to 15 weeks); the mean follow-up was 27 months (6 to 48 months). Results: The results were excellent in five cases, good in five, fair in seven, and poor in five cases. Bone and soft tissue infections were not encountered. Complications included skin slought (n=3), malunion having more than 5° tilt on the tibial joint surface (n=4), and post-traumatic osteoarthrosis that required ankle arthrodesis (n=1). Conclusion: Treatment with external fixators with limited open reduction or closed reduction is safe and effective in high energy fractures that may present an increased risk for wound healing problems when treated by the traditional method.

Limited open reduction and external fixation in the treatment of pilon fractures

Objectives: We evaluated the results of limited open reduction and external fixation in patients with pilon fractures. Methods: Sixteen male patients with pilon fractures underwent surgery by limited open reduction and external fixation. The mean age was 36 years (range 28 to 61 years). Five patients had multiple traumas and three patients had open fractures. According to the Ruedi classification, the fracturs were type I, II, and III in four, six, and six patients, respectively. Postoperative radiologic examinations were made using the criteria proposed by Ovadia and Beals. The mean follow-up period was 13 months (range 7 to 24 months). Results: The functional results were excellent, good, fair, and poor in one (6%), nine (56%), three (19%), and three (19%) patients, respectively. We obtained anatomic reduction in three patients, good reduction in eight, fair reduction in three, and poor reduction in two patients. Union was achieved within a mean duration of 18 weeks. Complications included pin-tract infection in two patients, and deep wound infection in one patient. Two patients had malunion and pseudoarthrosis, respectively. Conclusion: For a successful outcome, treatment of pilon fractures should include a limited surgical dissection with atraumatic handling of soft tissues, anatomic restoration of the articular surface, and an indirect fixation of the joint surface to the tibia shaft by an external fixator.

Displaced Three- and Four-Part Proximal Humerus Fractures: Evaluation and Management

Three- and four-part fractures are the most severe injuries in the spectrum of fractures of the proximal humerus. Despite the shortcomings of the currently available imaging techniques, fracture displacement remains an important principle in guiding management. As a result, increasing emphasis has been placed on the use of Neer's criteria in intraoperative decision making. Patients with four-part fractures with valgus impaction of the head fragment should be treated with limited open reduction and minimal internal fixation, as the blood supply to the humeral head is better preserved than with other fracture patterns and the potential for osteonecrosis is less. In the case of displaced three- and four-part fractures, the physiologic age and bone quality also help guide treatment selection. In young patients with good bone quality, attempts to preserve the humeral head by meticulous handling of soft tissues and the use of low-profile implants to secure fracture fragments is recommended. Vertical fixation alone with Rush rods in patients with poor bone quality and in those with four-part fractures is no longer considered adequate and should not be used. For selected patients with three-part fractures and satisfactory bone quality, fixation with Ender rods and tension-band wiring may be appropriate. Elderly patients and those with poor bone quality have a greater risk of loss of reduction after open reduction and internal fixation, and the current consensus is that early hemiarthroplasty is the appropriate treatment. Late reconstruction necessitated by malunion and soft-tissue contracture is technically difficult, and the outcome is less favorable. The outcome of treatment of three- and four-part fractures is dependent on the surgeon's ability to analyze the fracture pattern and execute appropriate techniques to restore anatomy and function. The use of cement for prosthetic fixation and rigorous attention to tuberosity stabilization and anatomic reduction are two factors that will optimize outcome. Adequate pain relief after hemiarthroplasty has been consistently demonstrated, but return of motion and function is less predictable.

Pilon Fractures

One hundred seven pilon fractures in 107 patients were treated according to a staged prospective protocol. All pilon fractures were stabilized immediately by the application of calcaneal traction. Open fractures or fractures in patients with multiple injuries were stabilized with traveling traction that was applied in the operating room. A distraction computed tomography scan was obtained before definitive treatment. Treatment groups were based on the degree of soft tissue compromise. Forty-one patients with Tscherne Grade 0 or Grade I injuries underwent open reduction and internal fixation (open plating) using contemporary techniques and low-profile implants. Sixty-four patients with Tscherne Grade II and Grade III closed injuries and all patients with open fractures underwent definitive treatment with limited open reduction and stabilization using small wire circular external fixators. Clinical and radiographic evaluations were performed at an average 4.9 years after injury. For all fracture types (AO classification), 81% of the patients who were treated with external fixation and 75% of the patients who were treated with open plating had good or excellent results. For severe fracture patterns (Type C), patients in both groups had significantly poorer results than patients with Types A and B fractures. The patients in the open plating group had a significantly higher rate of nonunion, malunion, and severe wound complications compared with the patients who received external fixation for Type C fracture patterns. Because of the increased incidence of bony and soft tissue complications when treating open or closed Type C fractures, use of limited exposures and stabilization with small wire circular external fixators is recommended.

Treatment of complex (Schatzker Type VI) fractures of the tibial plateau with circular wire external fixation: retrospective case review.

To determine the effectiveness of circular wire external fixation in the treatment of complex (Schatzker Type VI) fractures of the tibial plateau. Retrospective case series. Fifty-seven complex (Schatzker Type VI) fractures of the tibial plateau were treated with circular wire external fixation at a Level 1 trauma center. Thirty-five fractures were closed, and twenty-two were open. Closed indirect reduction by ligamentotaxis was attempted in all fractures; limited open reduction was performed in seven. Conventional Ilizarov frames using wire fixation were used in thirty-two fractures. The remaining twenty-five fractures were treated with hybrid Ilizarov fixators, which differed from conventional Ilizarov frames only in the use of cortical bone pins rather than wires through the distal rings for fixation of the diaphysis. The results were graded according to the Knee Society rating system. Follow-up ranged from 16 to 90 months and averaged 42 months. All fractures united at an average of 173 days (range, 50 to 415 days). Forty-five fractures with anatomic reduction had an average knee score of eighty-three and an average functional score of sixty-nine. In nine fractures with nonanatomic reduction, the average knee score was fifty-two, and the functional score was nineteen. Results perhaps would have been improved by more frequent open reduction, bone grafting, and internal fixation of fractures with severely depressed articular fragments. However, the use of circular external fixation obtained results comparable with other series, and we believe it is appropriate for treatment of these complex tibial fractures, especially those with a poor soft-tissue envelope.

Treatment of Articular Fracture of the Distal Tibia (Pilon Fracture) with Limited Open Reduction and External Fixator

Treatment of Articular Fracture of the Distal Tibia (Pilon Fracture) with Limited Open Reduction and External Fixator

ARTHROSCOPIC MANAGEMENT OF INTRA-ARTICULAR DISTAL RADIUS FRACTURES

Wrist arthroscopy is increasingly becoming recognized as an important adjunct in the management of displaced intra-articular fractures of the distal radius. Anatomic restoration of the articular surface is possible under bright, magnified conditions. Osteochondral loose bodies and associated intracarpal soft tissue injuries that may not be apparent on plain radiographs are detected and simultaneously managed. A method of management for displaced distal radius fractures using wrist arthroscopy and a combination of percutaneous and limited open reduction techniques are described.

Initial Clinical Experience with the IMEX™ Circular External Skeletal Fixation System

SummaryThe IMEX™ Circular External Skeletal Fixation (CESF) System was used to stabilize fractures (12 radius and ulna and five tibia and fibula) in 15 dogs and two cats and arthrodeses (two pancarpal, one talocrural and one pantarsal) in four dogs. The ages of the animals with fractures ranged from six months to nine years (mean ± SD: 2.7 ± 2.5 years; median: 2.0 years) and the body weights of dogs with fractures ranged from 5.4 kg to 48.6 kg (mean ± SD: 21.3 ± 12.6 kg; median: 22.7 kg). The ages of the dogs having arthrodeses ranged from eight months to two years (mean ± SD: 18±10 months; median: 18 months) and body weights of dogs with arthrodeses ranged from 19.0 kg to 29.1 kg (mean ± SD: 22.7 ± 4.7 kg; median: 21.4 kg). Ten fractures were open and four had been previously managed with another form of stabilization. Ten fractures were comminuted and all of the fractures involved the diaphysis; two extended to the distal metaphysis. An extensive open reduction was used on three, a limited open reduction on seven and a closed reduction on seven fractures. Arthrodeses were performed via a limited open approach, for debridement of the articular cartilage and implantation of a cancellous bone graft. Most animals placed substantial weight on the affected limb within a few days following the operations. Wire and pin track inflammation was the most common complication during the convalescent period and was often associated with a decrease in weight-bearing. Sixteen fractures achieved radiographic union (mean ± SD: 46 ± 13 days; median: 43 days) long-term function (direct examination: mean ± SD: 76 ± 38 days; median: 43 days; telephone communication: mean ± SD: 366 ± 247 days; median: 381 days) was assessed as excellent in 10 animals and good in seven. All of the arthrodeses achieved radiographic union (mean ± SD: 74 ± 31 days; median: 71 days). Longterm function (direct examination: mean ± SD: 185 ± 182 days; median: 102 days; telephone communication: mean ± SD: 485 ± 22 days; median: 590 days) was assessed as good in two dogs and fair in two dogs. Our results establish the utility of the IMEX™ CESF System for stabilizing fractures and performing arthrodeses in dogs and cats.The IMEX™ Circular External Fixator System was used to stabilize radius and ulna or tibia and fibula-fractures in 15 dogs and two cats and perform arthrodeses ir four dogs. Sixteen fractures and all four arthrodeses achieved radiographic union. Limb function was assessed as excellent in ten animals, good in nine animals and fair in two dogs.Presented at the 23rd Annual Conference of the Veterinary Orthopaedics Society, Telluride, CO, USA March 5, 1996 University of Florida Journal Series #547.

Management of Comminuted Fractures of the Distal Radius in the Adult

Displaced fractures of the distal radius are difficult to treat successfully by traditional nonoperative methods. The goal in the management of these fractures is to achieve extraarticular alignment and an articular step off of less than 2 mm. Cast immobilization has been supplemented with pins and plaster technique and external fixators. Percutaneous are limited open reduction techniques, combined with wrist arthroscopy, have been shown to be useful in the management of intraarticular distal radius fractures. Despite these advances, there are still a significant number of fractures in which the articular surface cannot be reconstructed without open reduction and internal fixation. The main objective is to restore articular integrity as perfectly as possible. Attention to meticulous surgical technique will facilitate good results. When articular restoration cannot be accomplished, early arthrodesis or arthroplasty should be indicated. In the absence of osteoarthritis, intraarticular osteotomy can be used for intraarticular malunions with a step off greater than 2 mm. Radius malalignment usually requires a dorsal opening wedge osteotomy, insertion of a corticocancellous graft, and a dorsal buttress plate. Early recognition and treatment of distal radioulnar joint injuries associated with fractures of the distal radius are paramount to reduce the incidence of painful sequelae and functional deficits.

Treatment of Tibial Pilon Fractures Using Ring Fixators and Arthroscopy

Twenty-one patients with tibial pilon fractures were treated with ring fixators and arthroscopy. There were 2 Type I, 14 Type II, and 5 Type III fractures using the Ruedi classification. In Ruedi Types I and II fractures, ring fixators were applied to the tibia and foot, and closed reduction was performed, monitoring the quality of the reduction with an image intensifier. When the quality of the reduction was questionable, arthroscopy was used, and if necessary, the reduction was readjusted. Olive wires were used to achieve reduction and fixation. In all Ruedi Type III fractures and 4 Ruedi Type II injuries, a limited open reduction was performed instead of arthroscopy. Approximately 8 weeks after the operation, the foot mounting was removed. The ring fixators were removed between 16 and 28 weeks. Bony union was achieved in all but 1. At an average followup of 37 months, there were 15 good, 4 fair, and 2 poor results. There were 8 cases of pin tract infection, and 1 patient had loss of reduction. There were no cases of deep wound infection. It was concluded that ring fixator and adjunctive arthroscopy is safe and effective in the management of tibial pilon fractures.

TREATMENT OF HIGH-ENERGY TIBIAL PLATEAU FRACTURES BY THE ILIZAROV CIRCULAR FIXATOR

We treated 24 patients with high-energy fractures of the tibial plateau by the Ilizarov fixator and transfixion wires. Eleven fractures were open, and 20 patients had complex injuries. Twelve were treated by ligamentotaxis and percutaneous fixation, seven by limited open reduction and five by extensive open reduction. All were followed for at least 24 months. All the fractures united, with an average time to healing of 14.4 weeks. Thirteen patients achieved full extension and 13 more than 110 degrees of flexion. Twenty-two knees were stable. Fifteen patients walked normally and the rest with only a slight limp. All but two knees had an articular step-off of less than 4 mm and all had normal axial alignment except two. There were no cases of postoperative skin infection, osteomyelitis or septic arthritis. Ilizarov circular fixation is an ideal method of treatment for these fractures when extensive dissection and internal fixation are contraindicated due to trauma to the soft tissue, deficiency of bone stock, and bony comminution.

Arthroscopically Assisted Reduction of Intraarticular Distal Radial Fractures

Anatomic restoration of the joint surface and extraarticular alignment is the goal in management of displaced distal radial fractures. Arthroscopy provides well lit, magnified conditions in which to reconstruct the fractured joint surface and to detect and manage intracarpal soft tissue injures associated with distal radial fractures. Percutaneous and limited open reduction techniques combined with wrist arthroscopy in the arthroscopically assisted management of displaced distal radial fractures is described.