title: Arthroscopic resection arthroplasty for malunited intra-articular distal radius fractures.
abstract: OBJECTIVE
  Cartilage damage of the carpals is a contraindication for corrective osteotomy of the malunited intra-articular distal radius fracture and typically is treated in the symptomatic patient with a salvage procedure. Here, we present our experience and early results with arthroscopic resection arthroplasty of the radiocarpal joint.
  
  
  METHODS
  We treated 10 patients (age, 17-68 y; average, 53 y) who had intra-articular malunion of the distal radius with mirror erosion on the carpals. The original fracture occurred 4 to 36 months (average, 9 mo) before our intervention. We performed arthroscopic arthrolysis and resected the offending portion of the radial malunited fragment, eliminating the stepoff and creating a smoother joint surface. Range of motion was started immediately after the operation, except in 2 patients.
  
  
  RESULTS
  The locations of the malunions were evenly distributed between the scaphoid fossa, the lunate fossa, or both. Stepoffs varied from 2 to 6 mm. We resected up to 60% of the entire radial articular surface to obtain a smooth surface (average, 28%; range, 20% to 60%). All patients reported immediate relief of pain and improvement in motion (particularly extension). At the latest follow-up (average, 28 mo; range, 13-42 mo), average extension improved from 24° to 54°, average grip strength improved from 47% to 89% of the contralateral wrist, average Disabilities of the Arm, Shoulder, and Hand score improved from 74 to 18, and average Patient-Rated Wrist Hand Evaluation score improved from 79 to 15.
  
  
  CONCLUSIONS
  The aim of the operation was to relieve patients' pain by providing a smooth, although fibrocartilaginous, surface for the carpus to glide on the radius. The follow-up was short and the results may be short-lived. However, for the younger patient, it may provide a temporary alternative to partial wrist arthrodesis with minimal morbidity, and for the less demanding patients, it may be a definitive procedure.
authors.affiliation: Instituto de Cirugía Plástica y de la Mano, Private Practice, and Hospital Mutua Montañesa, Santander, Spain. drpinal@drpinal.com
authors.forename: Francisco
authors.initials: F
authors.lastname: del Piñal
authors.forename: Melissa
authors.initials: M
authors.lastname: Klausmeyer
authors.forename: Carlos
authors.initials: C
authors.lastname: Thams
authors.forename: Eduardo
authors.initials: E
authors.lastname: Moraleda
authors.forename: Carlos
authors.initials: C
authors.lastname: Galindo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001178:Arthroplasty / Q000379:methods*; D001182:Arthroscopy; D005260:Female; D017759:Fractures, Malunited / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D057072:Intra-Articular Fractures / Q000601:surgery*; D012667:Lunate Bone / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D011885:Radius Fractures / Q000601:surgery*; D016059:Range of Motion, Articular; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology; D055815:Young Adult