Arthroscopic assessment of intraarticular distal radius fractures--results of minimally invasive fixation.

BACKGROUND: For many years, wrist arthroscopy has been used to diagnose and treat soft tissue lesions and to restore anatomic articular surface alignment in intraarticular fractures. However, there are no publications providing clear and precise indications for wrist arthroscopy in distal radius fractures. The aim of the study was to analyse factors influencing the outcomes of intraarticular distal radius fracture treatment with K-wire fixation under arthroscopic guidance in AO B1 and C1 type fractures. MATERIAL AND METHOD: A group of 26 patients (27 wrists) following an arthroscopic procedure (ARTR group) was the prospective component and 27 patients (27 wrists) following a non-arthroscopic procedure (OP group) constituted the retrospective part of the trial. Both groups consisted only of patients with B1 and C1 type fractures (10 and 17, respectively) according to the AO classification. RESULTS: In the ARTR group, there was a marked (statistically significant) difference between radiologically and arthroscopically assessed displacement. This underestimation of displacement was higher in B1 than C1 type fractures (statistically significant difference). Numerous associated injuries were identified, such as carpal bone cartilage injuries (85.19%), TFCC injury (59.26%) and SL ligament injuries (40.74%). Loose bodies were detected in 66.7% of the patients. In B1 type fractures, the most common ligamentous injury was a SL ligament lesion (50%), while in C1 fractures it was a TFCC lesion (70.59%). Comparing both groups (ARTR and OP), better clinical outcomes were observed in the ARTR group (though not statistically significant), with the most marked differences noted with regard to B1 type fractures. CONCLUSIONS: In B1 and C1 type intraarticular distal radius fractures, displacement visible during arthroscopy was greater than that seen on primary radiological assessment. In B1 type fractures, the difference between radiological and arthroscopic evaluation of displacement was more marked than in C1 fractures. It means that B1 type fractures can be highly "misleading", because their radiological pattern suggested little displacement, while actual displacement was more pronounced. On the basis of our results, it might be concluded that wrist arthroscopy could become a standard, routine procedure in B1 type fractures. In C1 type fractures, the method of treatment would depend on the surgeon's preferences.