title: Arthroscopic assistance does not improve the functional or radiographic outcome of unstable intra-articular distal radial fractures treated with a volar locking plate: a randomised controlled trial.
abstract: There is no consensus on the benefit of arthroscopically assisted reduction of the articular surface combined with fixation using a volar locking plate for the treatment of intra-articular distal radial fractures. In this study we compared the functional and radiographic outcomes of fluoroscopically and arthroscopically guided reduction of these fractures. Between February 2009 and May 2013, 74 patients with unilateral unstable intra-articular distal radial fractures were randomised equally into the two groups for treatment. The mean age of these 74 patients was 64 years (24 to 92). We compared functional outcomes including active range of movement of the wrist, grip strength and Disabilities of the Arm, Shoulder, and Hand scores at six and 48 weeks; and radiographic outcomes that included gap, step, radial inclination, volar angulation and ulnar variance. There were no significant differences between the techniques with regard to functional outcomes or radiographic parameters. The mean gap and step in the fluoroscopic and arthroscopic groups were comparable at 0.9 mm (standard deviation (SD) 0.7) and 0.7 mm (SD 0.7) and 0.6 mm (SD 0.6) and 0.4 mm (SD 0.5), respectively; p = 0.18 and p = 0.35). Arthroscopic reduction conferred no advantage over conventional fluoroscopic guidance in achieving anatomical reduction of intra-articular distal radial fractures when using a volar locking plate.
authors.affiliation: Aizawa Hospital, 1-5-2 Honjo, Matsumoto, 390-8510, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yamazaki
authors.affiliation: Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Uchiyama
authors.affiliation: Aizawa Hospital, 1-5-2 Honjo, Matsumoto, 390-8510, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Komatsu
authors.affiliation: Aizawa Hospital, 1-5-2 Honjo, Matsumoto, 390-8510, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Hashimoto
authors.affiliation: Aizawa Hospital, 1-5-2 Honjo, Matsumoto, 390-8510, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Aizawa Hospital, 1-5-2 Honjo, Matsumoto, 390-8510, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Sakurai
authors.affiliation: Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D001860:Bone Plates; D005260:Female; D005471:Fluoroscopy; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: Arthroscopy; Distal radius fractures; Fluoroscopy; Randomised controlled trial; Volar locking plate