Article
Corrective Osteotomy Arthroscopically assisted of Intra-Articular Distal Radius Malunions with out-in technique
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Authors
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Alberto Sgarbossa
- Istituto Clinico S. Anna, Brescia, Italy
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Conservative treatment or not correct surgical treatment of distal radial fractures carry out to healing with articular gap > 2mm with pain, loss of ROM and arthritic changes at midterm follow-up. The corrective osteotomy of intra-articular defects represent an complex challenge for surgeon. The surgical articular visualization is complex and a dorsal approach with capsula incision frequently evolve in stiffness as a result of capsular retraction. There was realized an technique for intra-articular distal radius malunions from outside to inside under dry arthroscopic visualization by the use of compass for define the correct site of osteotomy.
Methods: There performed surgery on 9 patients for intra-articular malunion of the distal radius 10 to 30 months after the injury, in all the cases the fractures was intra-articolar in 3 cases the step-offs was a consequence of incorrect surgical treatments in 6 cases was a consequence of conservative treatments in plaster. In 3 cases the osteotomy regarded more than 3 fragments. In 3 cases there was associated osteotomy of the extra-articolar distal radius.
Results and Conclusions: Follow-up ranged from 12 to 24 months. The articular joint was reconstruct without step-offs more than 1 mm, in 2 cases theres a partial dislocation of the fragment for not sufficient stable synthesis but the dislocation was less than 2 mm without clinical effect on rom restoration. According to the Gartland and Werley score, there were 3 excellent and 6 good results (mean score of 3.1). The Modified Green and O'Brien system achieved a mean score of 80, with 3 excellent, 5 good, and 1 fair results. The mobilization VAS has passed from 7 to 2 and the medium ROM improvement was 65°.
Arthroscopically assisted osteotomy permits direct visualization of the site of osteotomy and preserve the dorsal capsula and ligaments, the outside-inside technique by use of compass provide to draw very well the line of osteotomy, in comparison with arthroscopy inside-outside there was realized any time after fracture, there was an economic solution in exchange with navigated solution or custom mask of cutting techniques.
