2.3 Wrist arthroscopy in intra-articular distal radius fracture

Abstract

A clinical and radiological review of 119 distal radial fractures sustained in young adults to assess the longterm development of symptomatic arthritis and functional impairment. Eight hundred and one patients who had sustained a distal radial fracture between 1960 and 1968 were identified from the hospital records. Of these 119 who were below the age of 40 (mean 25 years) at the time of injury were reviewed at an average of 38 (33-42) years. one hundred and eighteen had been treated in a Colles plaster with or without manipulation for 6 weeks. All underwent a detailed physical examination, completed a self-reported validated questionnaire and underwent standardized radiographs of both wrists. No patient had changed occupation as a result of the fracture and none reported significant limitation of function. No salvage procedures had been performed. Eighty nine percent reported troublesome pain once per month or less. Flexion-extension was significantly reduced in the fractured wrist but by only 71. Grip strength was also significantly reduced but by an average of only 2 kg. Ninety percent of fractures had malunited in at least one radiological parameter and the fractured wrists had significantly more radiological arthrosis than the uninjured side. Logistic regression and ordinal logistic regression analysis demonstrated no relation between either malunion or radiological arthrosis and the objective or subjective outcome measures. Objective and subjective measures were however significantly related. The strongest predictor of fracture outcome was the function of the uninjured wrist. Malunion was well tolerated in this group of patients. We demonstrated no significant incidence of symptomatic posttraumatic osteoarthritis.Purpose: To compare the functionnal and radiological results concerning the ''same'' distal radius fracture of three different and consecutive procedures: dorsal plate, pins and palmar plate.Material and method: Sixty-two patients with a dorsally displaced extraarticular fracture of the distal radius were treated by dorsal plating [group 1, 20 patients, mean age 59.9 years (25-87)], pinning [group 2, 22 patients, mean age 55.6 years (17-83)] and volar plating [group 3, 20 patients mean age 57.1 years (17-78)]. Patients were evaluated by a surgeon not involved in treatment. Evaluations consisted of measurements of range of motion, grip strength, radiographic evaluations between postoperative time and last follow-up, and evaluation by Herzberg scoring, associated with Gartland and Werley rating system and completion of disability of arm, shoulder, and hand questionnaires. Comparison of three groups was performed with Kruskall-Wallis or ANOVA test and w 2 (P-value o0.05). Results: Operative time was the same for both plate groups but two times more than for the pin group. In Group 1 most complications and fair functional results were reported (32%) in spite of the longest follow-up. Group 3 showed the best results in flexion-extension, with DASH scoring, ulnar variance conservation, and most excellent...