Characteristics of secondary arthrofibrosis after intra-articular distal radius fracture.
OBJECTIVE
The purpose of this study was to assess characteristics of radiocarpal arthrofibrosis after intra-articular distal radius fractures (DRF).


METHODS
In this study 20 patients who underwent wrist arthroscopy at the time of implant removal after volar plating for intra-articular DRF were included retrospectively. The direction of fibrous tissue formation (FTF) and its rigidity were investigated. The findings were correlated to the course of intraarticular fracture lines seen in the preoperative CT, patient age and AO fracture types.


RESULTS
In all patients FTF spanned the radiocarpal joint. Fibrous tissue formations extended from previous fracture gaps to the scapholunate interosseous ligament and/or capsule. Four basic types of FTF (Type 1-4) and two combination types (Type 1a, 2a) were found. Fibrotic fans with dorsal capsular attachment (Type 1, 30 %) and its combination with dorsal capsule obliteration (Type 1a, 40 %) were the most common findings. Mild rigidity was present in 3 (15 %), moderate in 7 (35 %), and severe rigidity in 10 cases (50 %). Fracture lines crossing the radius extensor compartments or interfacet ridge, cartilage defects and C3 fractures showed the highest risk to develop severely rigid fibrous tissue formations. In older patients and in more comminuted fractures the number of rigid fibrous tissue formations was higher.


CONCLUSIONS
Fracture severity correlates with the development of rigid intra-articular FTF. In case of rigid FTF with restricted wrist motion arthroscopic debridement may be considered at the time of hardware removal.
Division of Hand Surgery, Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
M
M
Gabl
Division of Hand Surgery, Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
R
R
Arora
Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
A S
AS
Klauser
Division of Hand Surgery, Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria. gernot.schmidle@tirol-kliniken.at.
Gernot
G
Schmidle
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D002348:Carpal Bones / Q000473:pathology*; D005260:Female; D005355:Fibrosis / Q000145:classification / Q000209:etiology*; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D011884:Radius / Q000473:pathology*; D011885:Radius Fractures / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies
Arthrofibrosis; Arthroscopy; Distal radius fracture; Intra-articular; Wrist