This document discusses arthroscopically assisted fixation of distal radius fractures. Key points include: - Arthroscopy can optimize results for distal radius fractures by allowing for more accurate reduction and detection of concomitant ligament or TFCC injuries compared to fluoroscopy alone. - Common indications are intra-articular fractures, radial styloid fractures, die punch fractures, and fractures with suspected ligament or TFCC injuries. - Arthroscopy assists in assessing and managing injuries to the TFCC, scapholunate ligament, and other soft tissues that could affect outcomes. - Studies have found arthroscopically assisted fixation may lead to better mid-term results than open reduction internal fixation or fluor

1. Arthroscopicaly Assisted
Distal Radius Fixation
Nickolaos A. Darlis, MD, PhD
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2. “Thorough knowledge and
facility with classic techniques
of distal radius fracture
treatment is essential for a
good result”
Arthroscopy cannot
Reduce
Immobilize or
Promote healing
Del Piñal F, MD

3. …however Arthroscopy
can optimize results

4. Indications in Distal Radius Fractures
• Intrarticular (≈ 5-10% of all fx)
• Some extrarticular (DRUJ or
interosseous lig. injuries)

5. The “Miami Revolution”

6. Prognosis of distal radius fractures
• Shortening
• Angulation
• Step-off
• Ligamentous injuries
3mm
>100
Dorsal
2mm
AAOS 2010 WORKGROUP
RECOMENDATIONS

7. Prognosis of distal radius fractures
• Shortening
• Angulation
• Step-off
• Ligamentous injuries
3mm
>100
Dorsal
2mm
AAOS 2010 WORKGROUP
RECOMENDATIONS
BEST CONTROLED WITH
WRIST
ARTHROSCOPY

8. Articular Reduction
• Fluroscopic assessment of step-off, gap and rotation
is difficult, arthroscopy is more accurate
Catalano et al., 2004, Lutsky et al., 2008
• Accuracy of reduction does not predict final
functional outcome or satisfaction in elderly, low
demand patients
Young & Rayan, 2000

9. Concomitant lesions
• ΤFCC ≈60% (43-78%)
• SL lig.≈ 40% (32-75%)
• LT lig. ≈20% (15-61%)
• Chondral lesions ≈20% (19-32%)

10. Concomitant lesions
• “Most will heal by immobilization alone”
but…
• We know some will not
• We aim at early mobilization

11. Set-up

12. Set-up
• Alternative
– Ex –fix first
– Plate first

13. Reduction technique
– Intrafocal(Kapandji)
– Joystics
– Probe

14. Arthroscopically assisted reduction
• Currently indicated in selected injuries
– Radial styloid Fx
– Die Punch Fx
– Three & Four part Fx
– DRUJ instability or interosseous lig tear
• No metaphyseal comminution
• Especially in young, high demand patients

15. 1. Radial styloid

16. 1. Radial styloid

17. 1. Radial styloid

18. 1. Radial styloid

19. 1. Radial styloid

20. 1. Radial styloid

21. 1. Radial styloid

22. 2. die punch

23. 3. Three & Four part fractures

24. 3. Three & Four part fractures

25. SL management
L S L S SL
C
L S
I II III IV
I II III IV
GEISSLER-DAUTEL GRADING

26. SL management
• Debridement/ Thermal
shrinkage & Pinning

27. SL management
• Open repair

28. TFCC management
Central tear
Peripheral tear)
Radial tear
Deep bundle
of TFCC
radius
ulna

29. TFCC management
• Debridement
± pinning

30. TFCC management
• Debridement
± pinning

31. TFCC management
REPAIR TO CAPSULE
TFCC

32. TFCC management
REPAIR TO CAPSULE
TFCC

33. TFCC management
REPAIR TO CAPSULE
TFCC

34. TFCC management
REPAIR TO CAPSULE
TFCC

35. TFCC management
REPAIR TO CAPSULE
TFCC

36. TFCC management
REPAIR TO CAPSULE
TFCC

37. TFCC management
REATTACH TO FOVEA
TFCC

38. TFCC management
REATTACH TO FOVEA
TFCC

39. TFCC management
REATTACH TO FOVEA
TFCC

40. TFCC management
REATTACH TO FOVEA
TFCC

41. TFCC management
REATTACH TO FOVEA
TFCC

42. TFCC management
REATTACH TO FOVEA
TFCC

43. TFCC management
REATTACH TO FOVEA
TFCC

44. Plate & Scope
• Reported to be doable
Abe et al. 2008, Del Piñal F, 2011, Lutsky et al., 2008
• Significantly increases OR time
• Benefit questionable other than soft tissue injury

45. Dry arthroscopy
Courtesy: Del Piñal F, MD

46. Arthroscopically assisted reduction
• better results than both ORIF and fluoroscopically
assisted fixation in the mid-term
Doi et al, JBJS(A), 1999
Ruch et al, Arthroscopy, 2004
Varitimidis et al, JBJS(B), 2008
• Attribute results to better reduction or early
detection of lig. & TFCC lesions?
• Long term effect on post-traumatic arthritis still
unknown

47. Take Home Message
Optimize results in:
• Simple intrarticular fracture patterns amendable to
pin (and /or ex fix) fixation (styloid, die punch)
• Intrarticular or extrarticular fractures with high level
of suspicion for ligamentous or TFCC injury
• Young/ Active motivated patients

48. Whatever you do
• Remenber Vit C for disproportionate pain
• Reassess ligaments and TFCC status after fracture
healing
– Still window of opportunity
ACUTE
Good Healing
Potential
SUBACUTE
Unpredictable
CHRONIC
Poor Healing
Potential
0 6 months 1 year
3mo 6mo

49. Customize your approach
There is no single tool for every distal radius fracture

50. Thank you
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