Management of associated lesions in distal radius fractures

The wrist is a frequent source of pain, the clinical and radiographic investigation of which remains difficult. In this lecture, Dr. Obdeijn focuses on the importante of the amount of force used by the surgeon during wrist arthroscopy.

STT arthritis is a well-known problem generated idiopathically or secondary to a greater mobility of the scaphoid, for example after scapho-lunate ligament lesions. In these cases, the pure resection of the STT joint would add more instability to the whole system. Therefore, alternatively to the simple resection arthroplasty, the prosthetic augmentation has been proposed. We report the experience with a pyrocarbone convex-concave-shaped prosthesis, which adapts anatomically in the STT joint. After the arthroscopic resection of the distal scaphoid pole, the pyrocarbone implant can be positioned. Three weeks of immobilization seem convenient. In a series of 15 Prof. Christophe Mathoulin’s patients, very good results were achieved after a 39-month follow-up period. Two cases failed because of incomplete resection, especially at the most medial side towards the capitate, which should be approached in this area with accuracy. Arthroscopic resection and pyrocarbone prosthesis have provided very good results in isolated STT arthritis, but remain a new therapeutic option whose validity will have to be proven over the next years.

Scaphotrapeziotrapezoid (STT) joint osteoarthritis is less known than other types of wrist arthritis.
This disease accounts for only 13% of all wrist arthritis sites. Isolated lesions of this joint are rare and their therapeutic management is complex.
The only treatment proposed used to be STT arthrodesis, a technically difficult procedure which caused numerous complications.
Pseudoarthrosis is common, and STT arthrodesis has been incriminated in the occurrence of radioscaphoid osteoarthritis. Techniques of distal resection combined with interposition of biological tissues such as tendons (flexor carpi radialis) was described in the 1990s. In this video, we present arthroscopic interposition of pyrocarbon implant, a safe and convenient technique for patients, with long-lasting favorable results.

In this authoritative lecture, Dr. haugstvedt covers techniques and portals in arthroscopic surgery.

Treatment of intra-articular fractures of the distal radius has changed over the past decade. The contribution of wrist arthroscopy has allowed to reduce as precisely as possible the different fragments, but mostly it also allowed to see and treat associated lesions, especially intrinsic ligament tears, often leading to frequent and disabling sequelae.

In this key lecture, Dr. Cognet outlines the arthroscopic reduction of intra-articular distal radius fractures.

In this authoritative lecture, Dr. Nakamura outlines the current TFCC concept.

Fractures of the distal radius can cause major functional disorders when the reduction was not perfect, especially articular fractures. Treatment of malunion is difficult. It requires a deep understanding of the particular anatomy of the distal articular surface in direct contact with the wrist. A precise preoperative planning will reduce and fix the different fragments in good position.

In this key lecture, Dr. Gay focuses on arthroscopic resection of the ulno-carpal part of the ulnar head.

In this key lecture, Dr. Caroline Leclercq goes over the complications of wrist arthroscopy with an extensive survey of 10,107 cases.