Management of associated lesions in distal radius fracture

In this key lecture, Dr. Wahegaonkar focuses on arthroscopic dorsal capsuloligamentous repair in the management of SLIOL tears.

Wrist arthroscopy allows the diagnosis and particularly the treatment of internal injuries, avoiding large classical approaches. It is of course essential to perfectly know the anatomy of the various components of the very specific and rather complex architecture of the wrist.

Since the outstanding Nakamura's works in 2000, followed by the more recent Atzei's works, triangular fibrocartilage complex (TFCC) tears seem more complex than previously described by Palmer. In fact, the medial insertion of the TFCC is double: classic distal peripheral as described by Palmer, and proximal into the distal fovea of the ulnar head.
In this presentation, we report a convenient and simple technique to arthroscopically repair the distal component of the TFCC.

The author is presenting anatomical structures visible topographically on the surface of the volar and dorsal part of the wrist in relation to the wrist's inner anatomy. The author gives an X-ray picture, outside and inside topography of the wrist, and describes structures visible by the arthroscope in comparison to an anatomical dissection of radiocarpal and midcarpal joint. The author shows all details necessary for a good wrist access using the arthroscope and gives an overall picture of normal arthroscopic finding.

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. Camus outlines the wrist arthroscopic dorsal capsuloligamentous repair.

In this lecture, Dr. Camus focuses on wrist arthroscopic anatomy.

In this key lecture, Dr. Ho outlines arthroscopic bone grafting (ABG) in scaphoid non-union.

Post-traumatic osteoarthritis of the wrist often requires the use of palliative surgeries. Partial arthrodesis is one of the proposed techniques. They are numerous, and in this video, we report an original arthroscopic arthrodesis between scaphoid and capitate for localized osteoarthritis on the lateral side of the midcarpal joint, after an old chronic scapholunate ligament tear.

Purpose. – In carpometacarpal (CMC) arthritis of the thumb, the use of interposition techniques (polylactic acid, pyrocarbon, dacron) has been increasing recently. These techniques are most often combined with open or arthroscopic complete or partial trapeziectomy. This article reports the
results at one year of the arthroscopic interposition of an absorbable implant performed without trapeziectomy.
Methods. – Our series included 25 patients aged 60.5 years on average, presenting with osteoarthritis of the trapeziometacarpal joint that had been medically treated for 18.5 months on average. All patients were operated using 1-ulnar (U) and 1-radial (R) portals. After joint debridement, a polylactic acid implant was inserted under arthroscopic control. Outcome evaluation consisted of the assessment of pain intensity, grip strength, pinch strength, opposition, thumb abduction and Dell radiological staging.
Results. – The average follow-up was 14 months. Postoperative radiological data showed significant differences from baseline clinical data regarding all evaluated variables: 0.68 vs. 3.5 for pain, 24.76 Kg vs. 16.64 Kg for grip strength, 6.44 Kg vs. 3.64 Kg for pinch strength, 8.6 vs. 7.28 for opposition, 81.28 vs. 69.68 for thumb abduction, and 1.08 vs. 2.88 on the Dell stage. Eleven complications occurred, including a type 1 complex regional pain syndrome, one sepsis, and nine inflammatory reactions that resolved after an average of 3 weeks.
Conclusions. – Our technique is simple, rapid, cost-effective, and does not necessitate trapeziectomy, even partial. It has the same indications as other non-radical interventions. The follow-up duration of our study was too short for long-term evaluation but short-term outcome appeared superior to that in other published series. The regional inflammatory reactions that occurred in our series were transient and probably related to implant resorption. Our promising results suggest extending the indication of arthroscopic interposition to more advanced stages of proximal joint osteoarthritis.