Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures.
OBJECTIVE
Although arthroscopy offers an unparalleled view of intra-articular pathology, its use in the treatment of intra-articular distal radius fractures remains controversial. This study was designed to compare functional and radiologic outcomes of arthroscopically assisted (AA) versus fluoroscopically assisted (FA) reduction and external fixation of distal radius fractures.


METHODS
Retrospective, case-matched comparison of 2 different procedures.


METHODS
Between January 1995 and December 1999, 15 patients with comminuted intra-articular distal radius fractures underwent AA external fixation and percutaneous pinning. Fifteen patients underwent external fixation and FA reduction and pinning. Patients in both groups were matched for fracture pattern and age.


RESULTS
Follow-up evaluation consisted of an evaluation of grip strength and range of motion as well as radiographic evaluation of palmar tilt, radial shortening, stepoff, and degenerative changes. Health-related quality of life outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Patients who underwent AA surgery had significantly improved supination compared with those who underwent FA surgery (88 degrees v 73 degrees; P =.02). AA reduction also resulted in improved wrist extension (mean, 77 degrees v 69 degrees; P =.01) and wrist flexion (mean, 78 degrees v 59 degrees; P =.02). Radial shortening, Knirk and Jupiter congruity grades, and DASH scores were similar for both groups.


CONCLUSIONS
AA reduction and fixation of intra-articular distal radius fractures permits a more thorough inspection of the ulnar-sided components of the injury. At follow-up evaluation, patients who underwent AA procedures had a greater degree of supination, flexion, and extension than patients undergoing FA surgery.


METHODS
Level II prospective cohort study.
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1070, USA. druch@wfubmc.edu
David S
DS
Ruch
Jeff
J
Vallee
Gary G
GG
Poehling
Beth Paterson
BP
Smith
Gary R
GR
Kuzma
D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy; D005592:Fracture Fixation / Q000379:methods*; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000628:therapy; D018737:Hand Strength; D006801:Humans; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000628:therapy*