Article
The influence of arthroscopy, arthrotomy and conventional fluoroscopy in palmar locking plate fixation of intra-articular unstable distal radius fractures – a prospective randomized trial
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Authors
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Rohit Arora
- University Hospital Innsbruck, Department of Trauma Surgery, Innsbruck, Austria
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Tobias Kastenberger
- University Hospital Innsbruck, Department of Trauma Surgery, Innsbruck, Austria
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Lukas Horling
- University Hospital Innsbruck, Department of Trauma Surgery, Innsbruck, Austria
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Gernot Schmidle
- University Hospital Innsbruck, Department of Trauma Surgery, Innsbruck, Austria
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Markus Gabl
- University Hospital Innsbruck, Department of Trauma Surgery, Innsbruck, Austria
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: The objective is to evaluate arthroscopy (AS), arthrotomy (AT) and simple fluoroscopy (FS) in palmar plate fixation of intra-articular distal radius fractures (DRFs) and their correlation with clinical outcome. Our hypothesis was, that arthroscopy would lead to better reconstruction of the joint surface and detection of concomitant soft tissue injuries and thus leading to better clinical results
Methods: 58 patients (aged from 18 to 80) with intra-articular DRFs were randomized to one of the three groups (AS: n=20, AT: n=18, FS n=20). Palmar plate fixation was performed within 2 weeks. Pre- and postoperative CT scans were used to assess joint congruity and residual step off. Any additional soft tissue injuries that were detected were documented. On the follow up examinations at month 3, 6, and 12, patients were evaluated in terms of radiological parameters, pain, ROM and functional scores.
Results and Conclusions: Mean ROM: AS: Extension: 60°, Flexion 47°; FS: Extension: 59°, Flexion 46°; AT: Extension: 51°, Flexion 44°. Mean radial inclination: AS: 19.7°; FS: 20.1°; AT: 20.2°. Mean dorsopalmar tilt: AS: 5,9°; FS: 1,7°; AT: 2,5°. Mean ulnar variance was negative in all three groups (AS: -0,2 mm, AT: -0,2mm, FS: -0,5 mm). Post-operative mean step off in the joint: AS: 0.3mm; FS: 1.1mm; AT: 0.8mm. Mean grip-strength in AS: 28Kg; FS: 24Kg; AT: 21Kg. Partial scapholunate injuries (n=2 Grade 1 according to Geissler; n=1 Grade 2; n=2 Grade 3) were only seen in the AS group. Complete SL injuries were documented in the AS group (n=2 Grade 4), in the AT group (n=1 Grade 4) and none in the FS group. All complete SL ligament ruptures were treated by ligament fixation using bone anchors and K-wire fixation. Post-operative SL instability with an average increased SL-Joint gap in the stress X-rays of 2.1 mm compared to the uninjured side was measured in the FS group. TFCC lesions were detected in the AS group (n=3 Palmer type 1B; n=2 Palmer type 1C and n=2 Palmer type 1D).
Patients who were treated arthroscopically experienced significantly less pain over the entire follow up time compared to the other two groups. The average PRWE-Score at 12 months in the AS group was: 5 points; FS: 9 points; and in AT: 8 points. This difference was not significant.
The data shows a superiority of additional arthroscopy in palmar plate fixation in intra-articular DRFs, in regards to the radiological parameters, ROM, grip strength, pain and functional scores. Arthrotomy has the worst clinical outcome of the 3 groups.
