The usefulness of dry wrist arthroscopy in treatment of distal radius fracture : Case series

The development of wrist arthroscopy has made it possible to more accurately and less invasively restore articular congruency in the treatment of distal radius fracture. However, there is a risk of compartment syndrome due to fluid extravasaion, so a dry wrist arthroscopy technique been developed. The purpose of this study was to investigate the treatment results and complications of patients treated with dry wrist arthroscopy in the treatment of distal radial fractures to confirm its usefulness.

Among patients with distal radial fractures treated from January 2020 to July 2022, a total of 41 patients (27 females and 14 males) who underwent operative treatment using the dry wrist arthroscopy technique and retrospectively analyzed. Arthroscopy was performed when intra-articular stepping or gap greater than 2 mm, bony fragments in the joint, and accompanying ligament injury were confirmed on preoperative radiographs. Cannulated screw fixation was performed for B1 type fractures, and volar locking plate fixation was performed for all other fracture types. After reduction by intrafocal pinning or joystick method under image intensifier, temporary fixation was performed with K wire. In the case of using a volar plate, after applying the plate, the proximal screw was fixed with one or two screws, and the distal was fixed with K wire, and arthroscopy was performed to confirm the condition of the joint space. Arthroscopic findings, radiographic examinations, and patient charts were retrospectively analyzed. Operation time, fracture union, and complications were investigated. Pain visual analogue scale and the shortened disabilities of arm, shoulder and hand questionnaire (QuickDASH) were measured as clinical outcomes.

The average age was 56.1 years, and the average follow-up period was 25.3 months (13~38 months). Fracture union was achieved in all cases, and the average pain visual analogue scale score was 0.7 points and the average QuickDASH score was 2.77 points, showing good results. The average operative time was 77 minutes. Although reduction was performed before arthroscopy, additional reduction was performed because articular surface gap or depression was found in 11 cases at the time of surgery. Accompanying triangular fibrocartilage complex injury was confirmed in 8 cases, and chondral injury of the lunate was confirmed in 1 case. Acute scapholunate dissociation was confirmed in 2 cases. In 4 cases, bony or chondral loose bodies were identified and removed. Since there was no soft tissue swelling after arthroscopy, there was no difficulty in performing an additional open procedure to treat the accompanying metacarpal fracture or carpal fracture. There were no additional complications, and soft tissue problems such as compartment syndrome did not occur because water was not used.

In the treatment of distal radius fractures, dry wrist arthroscopy is a viable option for good treatment results. In distal radial fractures with intra-articular fractures, good results can be expected as intra-articular problems can be identified and resolved, and it is considered to be very useful because there is no possibility of soft tissue problems that can occur due to the use of water.

Keywords: Distal radius fracture, Dry wrist arthroscopy