Anatomical reduction of intra-articular fractures of the distal radius

Abstract

We treated 31 intra-articular fractures of the distal radius by arthroscopically-assisted reduction and percutaneous fixation with Kirschner (K-) wires. Tears of the triangular fibrocartilage (58 %), scapholunate (85 %) and lunotriquetral (61%) instability and osteochondral lesions (19%) were also treated. A total of 26 patients was independently reviewed at an average of 19 months. The mean pain score was 1.3/10, the range of movement 79% and the grip strength 90% of the contralateral wrist. Using the New York Orthopaedic Hospital score, 88% were graded excellent to good. On follow-up radiographs, 65% had no step and 31% had a step of < or =1 mm. Pain was significantly related to the size of the step. There was a significant difference in the incidence of persistent scapholunate diastasis and the Leibovic and Geissler grade (p < 0.01): I (0%), II (0%), III (42%) and IV (100%). We recommend anatomical reduction and acceptance of a step of <1 mm since the size of the step is related to the incidence of pain.

Influence of associated lesions of the intrinsic ligaments on distal radius fractures outcome

“…The incidence of SL and LT injury associated with distal radius fractures has been reported to range from 8 to 54 % and from 7 to 61 %, respectively [6,12,14,19,24,26].…”

Management of Intercarpal Ligament Injuries Associated with Distal Radius Fractures

“…In a retrospective review of 26 wrists treated exclusively with arthroscopically assisted fracture fixation using K-wires, the authors also treated 19 SLIL and 10 LTIL injuries. 4 The authors used percutaneous pinning techniques across the intercarpal articulations. They reported an overall 92% satisfaction with this treatment.…”

“…[1][2][3] The prevalence of ligamentous injury associated with fractures of the distal radius has been reported to be as high as 69% when partial injuries are included. 4 Injury to the scapholunate interosseous ligament (SLIL) has been reported to occur in 16% to 40% of patients [5][6][7] and injury to the lunotriquetral interosseous ligament (LTIL) in 8.5% to 15% of patients with distal radius fractures when evaluated arthroscopically. 5,7 Extension into the lunate facet 5 or greater than 2 mm in ulnar positive variance at the time of injury 8 were suggestive of an intercarpal ligament injury.…”

Analysis of the Arthroscopically Diagnosed Soft-Tissue Injuries Associated With the Distal Radius Fractures

“…The studies of Geissler [1], Mehta [25] and Hanker [26] examined only intraarticular fractures. According the study of Richards [11] and Ogawa [27] no significant difference existed between extra-and intraarticular fractures with respect to the frequencies of the ligamentous injuries.…”