Correction of malunited intra-articular distal radius fractures with an inside-out osteotomy technique.
OBJECTIVE
To present an inside-out osteotomy technique under arthroscopic guidance to correct an intra-articular malunion.


METHODS
The joint is explored with a 2.7-mm arthroscope through the standard portals without infusing any water. To allow room to introduce the curettes and the osteotomes (4-mm wide), the instrumentation portals are made slightly larger than usual. Malunited fragments are cut with the osteotomes from inside the joint and advanced out. Fragments are mobilized, and granulating tissue and/or new bone is removed with curettes and synoviotomes. After disimpaction and reduction, fixation with plates or screws via the appropriate open approach is performed under arthroscopic control. No water is used throughout the procedure except at the end of the surgery to clear out debris.


RESULTS
Steps were corrected to 0 mm in all patients. Gaps of less than 1 mm were common.


CONCLUSIONS
This procedure allows us to define each cartilage-containing fragment and to re-create the original articular fracture line without the fear of creating new fracture lines on the articular surface. This technique can be used for patients with irregularly defined fragments that are not amenable to classic techniques. The key to the procedure is to perform the arthroscopic exploration without water infusion (dry technique).
del Piñal
Francisco
F
Instituto de Cirugía Plástica y de la Mano, private practice, Hospital Mutua Montañesa, and the Clínica Mompía, Santander, Spain.
García-Bernal
Francisco J
FJ
Delgado
Julio
J
Sanmartín
Marcos
M
Regalado
Javier
J
Cerezal
Luis
L
D001182:Arthroscopy / Q000379:methods*; D001860:Bone Plates; D001863:Bone Screws; D005593:Fracture Fixation, Internal / Q000379:methods; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010027:Osteotomy / Q000379:methods*; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery*