Observation on the efficacy of minimally invasive approach to treat intra-articular fracture of distal radius with 1cm small incision sparing the pronator muscle combined with arthroscopy

To observe the feasibility and clinical effect of minimally invasive approach with 1cm small incision preserving anterior rotator muscle in the treatment of comminuted fracture of distal radius.

The clinical data of 63 patients with intra-articular distal radius fracture admitted to the Department of Orthopedics of Huangshi Aikang Hospital from September 2021 to February 2023 were retrospectively analyzed. According to the surgical method decided by the preoperative interview, 28 cases were treated with minimally invasive 1cm incision with the retention of pronator muscle assisted by wrist arthroscopy. The traditional Henry approach was used in 35 cases. The perioperative indexes and follow-up data of the two groups were compared.

All 63 cases were successfully operated. There were no significant differences in the general information, length of stay and grade of incision healing between the two groups (P＞0.05). Minimally invasive surgery time than traditional group increased [(90 ±7.2) vs (55±5.7), (P＜0.05)]. Postoperative follow-up was 6-13 months (mean 8.3 months). Postoperative complications such as wound infection, vascular and nerve injury were not found in the two groups. With the passage of time, VAS scores and wrist motion in all patients were gradually improved. When 3 days, 1 week after operation, the VAS score of minimally invasive was significantly lower than the traditional group [(3.8±2.2)vs(6.6±2.3), P=0.026; (3.2±1.4)vs(5.7±2.8), P=0.041]. There was no significant difference between the two groups at 1 month and 3 months after operation (P＞0.05). At postoperative 1 week, the flexion, rotation, activity of minimally invasive group was obviously better than the traditional group [(90±13,8)°vs(81±7.6) °, P=0.017; (79.6±9.2) °vs(61.1±15.6) °, P<0.001]. Three months after surgery, the MAYO wrist function score was 25/3 (89.2%) in the minimally invasive group and 29/6 (82.85%) in the traditional group, and the difference was statistically significant (P=0.039).

The minimally invasive approach with 1cm small incision preserving anterior rotator muscle for the treatment of distal radius intra-articular fracture has good operability and reliability, and has the advantages of less trauma, quick recovery, short pain period, and improved postoperative joint function, which is worthy of clinical application.

Keywords: intra-articular distal radius fracture,minimally invasive,pronator quadratus,Wrist arthroscope,quick recovery