Does arthroscopic assistance improve reduction in distal articular radius fracture? A retrospective comparative study using a blind CT assessment

  • M. SaabEmail author
  • P.-E. Wunenburger
  • E. Guerre
  • C. Chantelot
  • V. Morel
  • M. Ehlinger
  • Th. Bauer



The objective of this study was to compare the articular reduction in two groups of patients with a distal articular radius fracture who underwent surgery with versus without arthroscopic assistance. The initial hypothesis of this study is that arthroscopic assistance does not improve reduction in distal articular radius fractures.


The study was retrospective (1/04/2014–01/04/2017) and included 41 patients: 23 had arthroscopically assisted osteosynthesis, and 18 had not. All patients included had CT before and 3 months after surgery. All radiographic and CT measurements were retrospectively taken by an independent radiologist who did not know which operative technique was performed. Secondary judgement criteria were clinical analysis at 1-year follow-up and tourniquet time. We also reported all soft tissue injuries diagnosed and repaired and postoperative complications.


At the third month, articular step was 0.91 ± 1.25 mm (arthroscopy) and 1.41 ± 1.68 mm (no arthroscopy), without statistical difference (p = 0.3756). No difference was found for articular gap between the two groups [arthroscopy (0.55 ± 1.04 mm), (no arthroscopy (0.82 ± 1.54 mm)] (p = 0.8574). Except for the tourniquet time, clinical results at 1-year follow-up were not different. One patient of each group had a scapholunate pinning, and 6 patients of the arthroscopy group had a TFCC 1B injury, which was repaired.


This study did not demonstrate that arthroscopic assistance improves step and gap reduction of articular distal radius fracture, confirming initial hypothesis and recent literature data.

Level of evidence

Retrospective, III.


Wrist fracture Computed tomography Wrist arthroscopy Articular step Articular gap 


Author contribution

MS: Main author—acquisiton of data and manuscript writing. PEW: Secondary author—acquisition of data. VM: Analysis of data. EG: Interpretation of data, revision of manuscript. CC: revision of manuscript, study conception. ME: Data interpretation, critical revision, study conception. TB: Data interpretation, study conception.

Compliance with ethical standards

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Ethical approval

All procedures performed in this study, involving human participants, were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


  1. 1.
    Hardy P, Gomes N, Chebil M, Bauer T (2006) Wrist arthroscopy and intra-articular fractures of the distal radius in young adults. Knee Surg Sports Traumatol Arthrosc 14:1225–1230. Google Scholar
  2. 2.
    Varitimidis SE, Basdekis GK, Dailiana ZH, Hantes ME, Bargiotas K, Malizos K (2008) Treatment of intra-articular fractures of the distal radius: fluoroscopic or arthroscopic reduction? J Bone Joint Surg Br 90:778–785. Google Scholar
  3. 3.
    Abe Y, Tsubone T, Tominaga Y (2008) Plate presetting arthroscopic reduction technique for the distal radius fractures. Tech Hand Up Extrem Surg 12:136–143. Google Scholar
  4. 4.
    Levy S, Saddiki R, Normand J, Dehoux E, Harisboure A (2011) Arthroscopic assessment of articular fractures of distal radius osteosyntheses by percutaneous pins. Chir Main 30:218–223. Google Scholar
  5. 5.
    Yamazaki H, Uchiyama S, Komatsu M, Hashimoto S, Kobayashi Y, Sakurai T, Kato H (2015) 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. Bone Joint J 97-B:957–962. Google Scholar
  6. 6.
    Thiart M, Ikram A, Lamberts RP (2016) How well can step-off and gap distances be reduced when treating intra-articular distal radius fractures with fragment specific fixation when using fluoroscopy. Orthop Traumatol Surg Res 102:1001–1004. Google Scholar
  7. 7.
    Liverneaux P, Ichihara S, Facca S, Hidalgo Diaz J (2016) Résultats de l’ostéosynthèse par plaque antérieure et abord mini-invasif (MIPO) des fractures de l’extrémité distale du radius: mise au point. Hand Surg Rehabil 35S:S80–S85Google Scholar
  8. 8.
    Igeta Y, Vernet P, Facca S, Naroura I, Diaz JJH, Liverneaux PA (2018) The minimally invasive flexor carpi radialis approach: a new perspective for distal radius fractures. Eur J Orthop Surg Traumatol. Google Scholar
  9. 9.
    Mathoulin C, Sbihi A, Panciera P (2001) Interest in wrist arthroscopy for treatment of articular fractures of the distal radius: report of 27 cases. Chir Main 20:342–350Google Scholar
  10. 10.
    Forward DP, Lindau TR, Melsom DS (2007) Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am 89:2334–2340. Google Scholar
  11. 11.
    Hohendorff B, Eck M, Mühldorfer M, Fodor S, Schmitt R, Prommersberger K-J (2009) Palmar wrist arthroscopy for evaluation of concomitant carpal lesions in operative treatment of distal intraarticular radius fractures. Handchir Mikrochir Plast Chir 41:295–299. Google Scholar
  12. 12.
    Lindau T (2017) Arthroscopic evaluation of associated soft tissue injuries in distal radius fractures. Hand Clin 33:651–658. Google Scholar
  13. 13.
    Fontès D (2016) Pathology of the triangular fibrocartilaginous complex in distal radius fractures. Hand Surg Rehabil 35S:S60–S68. Google Scholar
  14. 14.
    Khanchandani P, Badia A (2013) Functional outcome of arthroscopic assisted fixation of distal radius fractures. Indian J Orthop 47:288–294. Google Scholar
  15. 15.
    Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL (1996) Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 78:357–365Google Scholar
  16. 16.
    Burnier M, Herzberg G, Izem Y, Joulie S (2013) Traitement des fractures articulaires du radius distal sous arthroscopie: le but anatomique est-il atteint? Revue de Chirurgie Orthopédique et Traumatologique 99:e22. Google Scholar
  17. 17.
    Christiaens N, Nedellec G, Guerre E, Guillou J, Demondion X, Fontaine C, Chantelot C (2017) Contribution of arthroscopy to the treatment of intraarticular fracture of the distal radius: retrospective study of 40 cases. Hand Surg Rehabil. Google Scholar
  18. 18.
    Müller ME, Nazarian S, Koch P (1987) Part 2: Classification AO des Fractures: Tome I: les os Longs, 1st edn. Springer, BerlinGoogle Scholar
  19. 19.
    Atzei A, Luchetti R, Sgarbossa A, Carità E, Llusà M (2006) Set-up, portals and normal exploration in wrist arthroscopy. Chir Main 25S1:S131–S144. Google Scholar
  20. 20.
    Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 14:594–606Google Scholar
  21. 21.
    Bain GI, Munt J, Turner PC (2008) New advances in wrist arthroscopy. Arthroscopy 24:355–367. Google Scholar
  22. 22.
    Cooney WP, Bussey R, Dobyns JH, Linscheid RL (1987) Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 214:136–147Google Scholar
  23. 23.
    Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608.;2-L Google Scholar
  24. 24.
    Arora S, Grover SB, Batra S, Sharma VK (2010) Comparative evaluation of postreduction intra-articular distal radial fractures by radiographs and multidetector computed tomography. J Bone Joint Surg Am 92:2523–2532. Google Scholar
  25. 25.
    Cole RJ, Bindra RR, Evanoff BA, Gilula LA, Yamaguchi K, Gelberman RH (1997) Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg Am 22:792–800Google Scholar
  26. 26.
    Hunt JJ, Lumsdaine W, Attia J, Balogh ZJ (2013) AO type-C distal radius fractures: the influence of computed tomography on surgeon’s decision-making. ANZ J Surg 83:676–678. Google Scholar
  27. 27.
    Heo YM, Roh J-Y, Kim S-B, Yi JW, Kim KK, Oh BH, Oh H-T (2012) Evaluation of the sigmoid notch involvement in the intra-articular distal radius fractures: the efficacy of computed tomography compared with plain X-ray. Clin Orthop Surg 4:83–90. Google Scholar
  28. 28.
    Zemirline A, Taleb C, Facca S, Liverneaux P (2014) Minimally invasive surgery of distal radius fractures: a series of 20 cases using a 15 mm anterior approach and arthroscopy. Chir Main 33:263–271. Google Scholar
  29. 29.
    Swart E, Tang P (2017) The effect of ligament injuries on outcomes of operatively treated distal radius fractures. Am J Orthop 46:E41–E46Google Scholar
  30. 30.
    Gehrmann SV, Windolf J, Kaufmann RA (2008) Distal radius fracture management in elderly patients: a literature review. J Hand Surg 33:421–429. Google Scholar
  31. 31.
    Lebailly F, Zemirline A, Facca S, Gouzou S, Liverneaux P (2014) Distal radius fixation through a mini-invasive approach of 15 mm. PART 1: a series of 144 cases. Eur J Orthop Surg Traumatol 24:877–890. Google Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Service d’orthopédie BHôpital Roger-Salengro, CHRU de LilleLille CedexFrance
  2. 2.Service Radiologie et Imagerie MusculosquelettiqueHôpital Roger Salengro, CHRU de LilleLille CedexFrance
  3. 3.Service de Chirurgie Orthopédique et de TraumatologieHôpital de HautepierreStrasbourg CedexFrance
  4. 4.Service Chirurgie Orthopédique et TraumatologieHôpital Ambroise Paré AP-HPBoulogne-BillancourtFrance

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