13. Arthroscopy cannot
Reduce
Immobilize or
Promote healing
“Thorough knowledge and
facility with classic techniques
of distal radius fracture
treatment is essential for a good
result”
Del Piñal F, MD
18. Prognosis of distal radius fractures
AAOS 2010 WORKGROUP
RECOMENDATIONS
• Shortening
3mm
• Angulation
>100
• Step-off
• Ligamentous injuries
Dorsal
2mm
BEST CONTROLED WITH
WRIST
ARTHROSCOPY
19. 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
24. 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
57. 1. Central TFCC lesions
• Often degenerative and associated
with ulnocarpal impaction
syndrome
• Ulnar recession procedure to
prevent symptom recurrence
58. Ulnocarpal Impaction Syndrome
Clinical features:
• Ulnar sided wrist pain
• Associated degenerative changes:
–
–
–
–
Ulnar side of the lunate
Radial side of the ulnar dome
TFCC central tear
Triquetrum- LunoTriquetrum lig.
• Usually positive or neutral ulnar variance
82. Take Home Message _Fractures
Arthroscopy can 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
83. Take Home Message _ TFCC
Arthroscopy has revolutionalized the way we
understand and treat TFCC lesions:
• Beware of ulnocarpal impaction in central tears
• Suspect foveal detachment and treat it (arthro or
open)
84. Whatever you do
• Remenber Vit C for disproportionate pain
• Reassess ligaments and TFCC status after fracture
healing
– Still window of opportunity
0
6 months
ACUTE
Good Healing
Potential
3mo
SUBACUTE
Unpredictable
6mo
1 year
CHRONIC
Poor Healing
Potential