Arthroscopic-assisted volar plate fixation for intra-articular distal radial fractures treated: A comparative study at tertiary care centers in Jakarta, Indonesia

Intra-articular distal radius fractures are common injuries that pose challenging treatment for orthopaedic surgeons. Recently, volar plate fixation using wrist arthroscopy has gained popularity, despite no consensus regarding its benefits. This study compared the functional and radiological outcomes of volar plating techniques with and without arthroscopic assistance in patients with intra-articular distal radius fractures.

This retrospective study included patients with intra-articular distal radius fractures. Patients were divided into two groups: one group underwent volar plating with arthroscopy, and the other without. Functional outcomes, radiological outcomes, and complications regarding the procedure were evaluated at 1 and 3 months post-operatively.

We included 50 subjects (mean age: 34.3 ± 9.02 years) in this study. Thirty subjects underwent conventional volar plate fixation, and twenty underwent arthroscopic-assisted volar plate fixation. Radiological outcomes showed a statistically significant difference (p<0.001) in postoperative palmar tilt with 6.93 ± 9.2° and 9.77 ± 5.07° in the non-arthroscopic and arthroscopic group, respectively, indicating a better palmar tilt outcome in the latter group. The arthroscopic group showed better early PRWE score compared to the non-arthroscopic group [120 (97 - 148) vs. 125,5 (111 – 143); p= 0.011]. However, the PRWE score was not significantly different at three months post-operatively (p = 0.058). Other parameters such as Mayo Wrist, DASH, and grip strength also showed a better outcome in the arthroscopic group, though they were not statistically significant. The postoperative range of motion on the arthroscopic group showed improvements in extension [83° (45 - 100) vs.62,5° (10 - 75); p <0,001] and radial deviation [20 (10 - 25) vs. 15 (5 - 20); p= 0,033] compared to non-arthroscopic group. No complications were recorded between the group after three months.

Arthroscopic-assisted volar plate fixation provides superior outcomes in several functional aspects compared to the technique without arthroscopy. However, these results need further validation with larger samples and longer follow-up periods.

Keywords: distal radius, fracture, intra-articular, arthroscopy, volar plating