Arthroscopic-Assisted Reduction of Intra-Articular Distal Radius Fracture

ORIF for Distal radius fracture was quite common in the daily practice of every hand surgeon or orthopedic surgeon. However, for intra-articular fracture we mostly rely on 2-D image from C-arm fluoroscopy to guide reduction, rather than performing open arthrotomy with higher risk of damage to radiocarpal ligaments. For wrist joint which is relatively a small-sized joint with different shape of scaphoid fossa/lunate fossa and important intrinsic /extrinsic ligaments, wrist arthroscope assisted surgery provide a comprehensive way to manage the articular fracture and soft tissue injuries simultaneously.  

Wrist arthroscope surgery, like any other scope procedure, is a minimally invasive surgery providing great magnified field of view. Through radiocarpal and midcarpal portals, we could detect any distal radius articular step-off or gap, cartilage wear, bony defect, TFCC rupture, ligament injury, capsule fibrosis or synovitis. 

The distal radius articular surface and whole radio-carpal joint could be examined through 34 and 6R portal. According to fracture pattern, the displaced articular fragment could be reduced with k-wires as joystick, and the die-punched fragment could be elevated with intra-focal insertion of curved probe to achieve proper articular surface reduction. TFCC should be primarily repaired if foveal rupture with unstable DRUJ was found. Through MCR and MCU portal, we could check if there is concurrent scaphoid fracture and the degree of SLIL/LTIL injury, then treat these associated injuries at the same time. The disadvantage of wrist scope assisted technique is that it takes some learning curve to familiarize with portal setting and equipment handling. 

In summary, for intra-articular distal radius fracture, arthroscope assisted reduction and management is a precise, effective, real-time adjustable and minimally invasive solution especially for young or high function demand patient, die punch lesion, combined scaphoid fracture, TFCC or SLIL injury, and intra-articular malunion.