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Anatomical reduction of intra-articular fractures of the distal radius

AN ARTHROSCOPICALLY-ASSISTED APPROACH

Modbury Public Hospital, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia.

Correspondence should be sent to Mr G. I. Bain at 206 Melbourne Street, North Adelaide, South Australia 5006.

We treated 31 intra-articular fractures of the distal radius by arthroscopically-assisted reduction and percutaneous fixation with Kirschner (K-) wires. Tears of the triangular fibrocartilage (58%), scapholunate (85%) and lunotriquetral (61%) instability and osteochondral lesions (19%) were also treated.

A total of 26 patients was independently reviewed at an average of 19 months. The mean pain score was 1.3/10, the range of movement 79% and the grip strength 90% of the contralateral wrist. Using the New York Orthopaedic Hospital score, 88% were graded excellent to good. On follow-up radiographs, 65% had no step and 31% had a step of 1 mm. Pain was significantly related to the size of the step.

There was a significant difference in the incidence of persistent scapholunate diastasis and the Leibovic and Geissler grade (p < 0.01): I (0%), II (0%), III (42%) and IV (100%).

We recommend anatomical reduction and acceptance of a step of <1 mm since the size of the step is related to the incidence of pain.