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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Operative Treatment of Intra-Articular Distal Radius Fractures With versus Without Arthroscopy: RADAR Trial

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  • presenting/speaker Caroline Selles - Maasstad Hospital, Rotterdam, Netherlands
  • Marjolein Mulders - Amsterdam UMC, Amsterdam, Netherlands
  • Joost Colaris - Erasmus MC, Rotterdam, Netherlands
  • Mark Van Heijl - Amsterdam UMC, Amsterdam, Netherlands
  • Berry Cleffken - Maasstad Hospital, Rotterdam, Netherlands
  • Niels Schep - Maasstad Hospital, Rotterdam, Netherlands

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-400

doi: 10.3205/19ifssh0760, urn:nbn:de:0183-19ifssh07608

Published: February 6, 2020

© 2020 Selles et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation: Open reduction and internal fixation (ORIF) for intra-articular distal radius fractures leads to a quicker recovery of function compared to non-operative treatment. However, some patients continue to have a painful and stiff wrist postoperatively. Arthroscopically assisted removal of intra-articular fracture hematoma and debris may improve the functional outcomes following operative treatment of intra-articular distal radius fractures. The purpose of this randomized controlled trial is to determine the difference in functional outcome, assessed with the Patient-Rated Wrist Evaluation (PRWE) score, after ORIF with and without an additional wrist arthroscopy in adult patients with displaced complete articular distal radius fractures.

Methods: In this multicenter trial adult patients with a displaced complete articular distal radius fracture are randomized between ORIF with an additional wrist arthroscopy to remove fracture haematoma and debris (intervention group) and conventional fluoroscopic assisted ORIF (control group). The primary outcome is functional outcome assessed with the PRWE score after 3 months. Secondary outcomes are wrist function assessed with the Disability of the Arm, Shoulder and Hand (DASH) score, post-operative pain, range of motion, grip strength, and complications. Additionally, in the intervention group the quality of reduction, associated ligamentous injuries and cartilage damage will be assessed. A total of 50 patients will be included in this study.

Results and Conclusions: A total of 50 patients were randomized, 25 to the intervention group and 25 to the control group.

All patients who had arthroscopic treatment had a hematoma which was removed. All patients had an associatied injury consisting of TFCC, SL, LT or damage to the scaphoid or lunate fossa.

Median PRWE was not significantly better for the intervention group at 3 weeks (48 [25-67] vs 58 [44-73], p = 0.1), and at 6 weeks (37 [18-63] vs 39 [19-53], p = 0.7). Median PRWE was significantly worse for the intervention group at 3 months (23 [9-44] vs 13 [5-21], p = 0.02). At six months follow-up both groups had a PRWE of 10 (p= 0.3). Complications were equal in both groups; 7 complications in the intervention group and 7 in the control group.

Additional arthroscopy after ORIF, compared to only ORIF, does not lead to better functional outcomes in patients with displaced intra-articular distal radius fractures.