Management of associated lesions in distal radius fracture

Ulno-carpal impaction syndrome is often secondary to the sequels of a fracture of the distal radius.
The inversion of the distal radio-ulnar index with a positive ulnar variance by shortening relative to the radius eventually leads to an abutment between the head of the ulna and the proximal articular face of the lunate. This contact leads to the alteration of the cartilaginous carpal surfaces. There are numerous treatments for the distal radio-ulnar component of malunion of distal radius fracture and the choice of therapy is based on specific evaluation of this joint through a clinical and radiological analysis.
Arthroscopy remains the best diagnostic element in evaluating the seriousness of the ulno-carpal abutment with a direct visualization of the cartilaginous lesions and allowing a precise assessment of the associated lesions, in particular on TFCC or LT ligament. When the inversion of the distal radio-ulnar index is less than or equal to 5mm, the surgical treatment can also be carried out by arthroscopy.

In this authoritative lecture, Dr. Michel Levadoux goes over the arthroscopic partial scaphoid implant.

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.

Arthritis of the proximal interphalangeal (PIP) joint has long presented a challenge for both surgeons and patients alike. The interplay between the joint’s soft tissue and bony anatomy is complex, as the components must work in tandem to provide an acceptable balance of both stability and motion. In the past, arthrodesis, or fusion of the joint with compression screw fixation and plating systems, was the gold standard in the treatment of arthritic joint conditions. PIP joint arthroplasty using a silicone implant is an old but safe procedure in people who do not need to use their labor force.

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

In this authoritative lecture, Dr. Baur goes over arthroscopic distal ulna resection in the management of ulnar impaction syndrome.

The triangular fibrocartilage complex (TFCC) is actually more complex than it appears to be. Arthroscopy of the wrist has helped to better understand the various insertions of this proximal and distal triangular complex and to detect these lesions. The adapted treatment of these lesions made it possible to prevent failures of the conventional arthroscopic reinsertions with the disappearance of the associated distal ulnar instabilities when only a part of the problem was treated.
The healing potential of the TFCC largely depends on its vascularization. This video shows the arthroscopic repair of a peripheral distal tear of the TFCC with the in-out technique.

The triangular fibrocartilage complex (TFCC) has an important biomechanical function for the carpus and the distal radioulnar joint. TFCC lesions are responsible for ulnar side wrist pain and need to be repaired in order to restore a normal wrist. In some cases, TFCC lesions range from ulnar styloid to radial insertion. Wrist arthroscopy makes diagnosis and treatment possible in the least invasive way. The surgical treatment consists in reinserting the TFCC using the new double loop suture with absorbable PDS material. The film describes how to place a double suture of the entire TFCC tear by using an only one-way suture technique.

Wrist arthroscopy is a technique which has revolutionized the treatment of wrist pathologies. To better understand it, it is necessary to use a suitable equipment and use mini approaches as demonstrated in this educational video.

In this key lecture, Professor Herzberg looks into the techniques for arthroscopic radial styloidectomy.