Arthroscopic Management of Intra-articular Ligament Lesions on Distal Radius Fractures

Abstract

Articular distal radius fractures (DRFs) have increased in incidence in recent years, especially among the economically active population. Most of the treatment approaches are based on plain X- rays, and do not give us any information on how to treat these fractures. In the search for solutions with greater precision in diagnosis, in reducing the joint surface of the fracture, and envolving minimally-invasive techniques, we found arthroscopy as the main tool for these patients. Therefore, an enhanced understanding of the biomechanics of the different types of fracture associated with ligamentous lesions should facilitate the right decision regarding the treatment. The present paper aims at providing a management-oriented concept to diagnose and treat ligamentous lesions associated with intra-articular DRFs based on a arthroscopy-assisted procedure, and showing the objective and patient-reported outcomes and a new classification. The objective and patient-reported outcomes were: the mean range of motion (ROM) was of 94.80% on the non-affected side; the mean score on the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) was of 3.6 (range: 1 to 12). The score on the Visual Analog Scale (VAS) was of 1.66 (range: 1 to 3). Complications were observed in 2 (13.33%) patients: extensor tendon synovitis in 1 patient, and a limitation (stiffness) in ROM in 1 patient, both treated with wrist arthroscopy release. The mean time until the return to work was of 6.4 weeks. In patients with unstable intra-articular DRFs associated with ligamentous lesions, the fixation of specific osseous-ligamentous fragments and ligamentous repair/reconstruction by wrist arthroscopy prove to be a safe and reliable treatment. The clinical and functional results predict that the patients can return to work more quickly.

Fracturas de Radio Distal con Lesiones Concomitantes de Codo. Un Análisis Prospectivo

“…This method provided adjunctive fixation and DRUJ stabilization. 12 Now, DRUJ and PRUJ were clinically and intra-operatively tested by using the Pull radius and ballotement tests (negatives now), with full pronation and supination showing a normal congruency and stability between the ulnar head and the sigmoid notch. All patients were assessed radiographically and clinically at 12 months.…”

“…Abordaje de lesiones ligamentarias asociadas (codo o muñeca) 12 -a. reparable -Retracción térmica por radiofrecuencia de las fibras del ligamento -Reinserción CFCT con anclajes / internal brace®) (ver ►Video 1). -sutura directa (ver ►Video 2) Para los casos con disociación radiocubital longitudinal, se realizó un abordaje radial, en el que se cosechó el tendón BR y se preparó con un aparato ortopédico interno seccionando el tendón en su transición muscular y preservando la inserción en la estiloides del radio.…”

“…Este método proporcionó fijación complementaria y estabilización ARCD. 12 Ahora, ARCD y ARCP se probaron clínica e intraoperatoriamente utilizando las pruebas de radio de tracción y ballotement (negativas ahora), con pronación y supinación completas que mostraban una congruencia y estabilidad normales entre la cabeza cubital y la escotadura sigmoidea. Todos los pacientes fueron evaluados radiográfica y clínicamente a los 12 meses.…”

“…Se animó a los pacientes a realizar actividades que evitaran la sobrecarga o los cambios en la función. 12…”