title: Arthroscopic reduction of comminuted intra-articular distal radius fractures with diaphyseal-metaphyseal comminution.
abstract: OBJECTIVE
  In the setting of severely comminuted diaphyseal-metaphyseal fractures of the distal radius, arthroscopic reduction of the joint surface is difficult and often results in shortening and collapse. Yet, several authors have shown the benefits of arthroscopy in articular distal radius fractures. We present a method that safely allows a combination of arthroscopic reduction and rigid fixation and describe the outcomes in a small group of patients.
  
  
  METHODS
  Four consecutive patients with severely comminuted diaphyseal-metaphyseal articular fractures of the distal radius were treated using the stable reference fragment technique. For all cases, we used an extra-long volar locking plate applied to the diaphysis of the radius. Preoperative computed tomography scanning was used to identify the largest articular fragment. This reference fragment was reduced and stabilized with locking pegs or screws to the volar plate under fluoroscopic guidance. The articular reduction continued arthroscopically, using the reference fragment as a guide. Once the articular reduction was complete, the comminuted metaphysis was addressed and secured to the plate.
  
  
  RESULTS
  All patients achieved excellent clinical and radiological results. Flexion-extension averaged 124° and pronation-supination averaged 174°. One patient showed minor signs of radiocarpal osteoarthritis on radiographs at 3 years.
  
  
  CONCLUSIONS
  By securing the reference fragment before addressing the metaphyseal comminution, a stable platform was created. Thus, intra-articular reduction was achieved while maintaining extra-articular alignment. Although the results were excellent, the number of cases was small.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Instituto de Cirugía Plástica y de la Mano, Private Practice, and Hospital Mutua Montañesa, Santander, Spain. Electronic address: drpinal@drpinal.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Del Piñal
authors.affiliation: Instituto de Cirugía Plástica y de la Mano, Private Practice, and Hospital Mutua Montañesa, Santander, Spain.
authors.forename: Melissa
authors.initials: M
authors.lastname: Klausmeyer
authors.affiliation: Instituto de Cirugía Plástica y de la Mano, Private Practice, and Hospital Mutua Montañesa, Santander, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Moraleda
authors.affiliation: Instituto de Cirugía Plástica y de la Mano, Private Practice, and Hospital Mutua Montañesa, Santander, Spain.
authors.forename: Guillermo H
authors.initials: GH
authors.lastname: de Piero
authors.affiliation: Instituto de Cirugía Plástica y de la Mano, Private Practice, and Hospital Mutua Montañesa, Santander, Spain.
authors.forename: Jaime S
authors.initials: JS
authors.lastname: Rúas
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D001860:Bone Plates; D001863:Bone Screws; D018483:Diaphyses / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053401:Palmar Plate / Q000601:surgery; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Arthroscopy; articular distal radius; comminuted fractures; wrist