Article
“Stepwise” method of arthroscopic reduction and plate fixation of intra-articular distal radius fractures – an evolution of technique and instrumentation
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Authors
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Nicholas Smith
- Sydney, Australia
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation: Arthroscopic visualisation of articular fractures of the distal radius can allow accurate reconstruction of the articular surface whilst minimising disruption of the dorsal capsular structures. In minimising the iatrogenic injury, this may lead to improved outcomes,though this remains unproven.
Technically, one of the most challenging problems is how to hold the reduction while definitive fixation is employed. Where a volar locking plate is used, typically the plate is applied with proximal fixation, prior to the arthroscopy and articular manipulation. Two technical difficulties often ensue. Firstly maintaining accurate reduction of volar fragments after applying traction. Secondly, inserting distal locking fixation whilst holding the articular reduction under arthroscopic visualisation with the wrist in traction. It is difficult to simultaneously maintain traction for arthroscopy, and retraction to allow safe introduction of the drill and screws.
Methods: The stepwise technique and the newly evolved fixation are presented.
A trans FCR approach is used. The volar cortex is reduced under direct vision. The plate is fixed proximally with screws. Interference K-wire sleeves are then applied to the distal locking screw holes. K-wires are then introduced only as far as the volar fragments, using II. The dorsal fragments remain free.
Traction is applied, dry arthroscopy performed using 1/2, 3/4 and 6R ports.
The articular surface is reduced by the surgeon and provisionally fixed by advancing the wires. Traction is removed, correct wire length assessed with II. Using the cannulated system, peg length is calculated, the sleeve removed, the wire overdrilled, and cannulated locking pegs inserted over the wires.
Results: Some cases will be briefly presented to illustrate the technique.
Discussion: The technique may bring this technically challenging method into the repertoire of most capable wrist arthroscopists. As each step of the surgery is completed, the articular surface is brought closer to anatomical alignment, with increasing stability. The chance of a backwards step is minimised, decreasing frustration and optimising the result.
Conclusion: An evolution of surgical technique and instrumentation for arthroscopic reduction and stable fixation of exploded articular fractures of the distal radius is presented.
