Arthroscopic Assistance
Inconsistent evidence suggests no difference in outcomes between use of arthroscopic assistance and no arthroscopic assistance when treating patients for distal radius fractures.
Management of Distal Radius Fractures
This guideline was produced in collaboration with ASSH Endorsed by: AAHS, ASHT

Rationale

There was 1 high (Yamazaki, H 2015), and 2 moderate strength (Varitimidis, SE 2008 and Selles, CA ) studies evaluating the use of wrist arthroscopy as an adjunctive treatment for distal radius fracture fixation. Although many comparative studies have been done, the variability of study design, surgical indications, fracture classification systems and implants used makes interpretation of the literature challenging. Evaluation of these studies, however, does not show apparent treatment benefit for the use of wrist arthroscopy at the time of distal radius fracture fixation. 

One high strength study (Yamazaki, H 2015 ) that specifically evaluated arthroscopic-aided reduction and fluoroscopy with fluoroscopy alone at the time of distal radius fracture fixation with volar locking plate technology did not show a significant difference in patient functional outcomes at 48 months. This finding is corroborated by a moderate quality study (Selles, CA 2019) that also compared the intraoperative use of wrist arthroscopy to remove fracture hematoma and debris with a similar cohort treated by open reduction and internal fixation. Here also, a significant difference in outcome could not be determined at 12 months. One moderate strength study (Varitimidis, SE 2008) did conclude that some parameters of radiographic outcome could be improved using a combination of distal radius fracture fixation, arthroscopic evaluation, and fragment-specific pinning and that these patients had improved clinical outcomes. 

Risks and Harms of Implementing this Recommendation

There are no known harms associated with implementing this recommendation as it supports not using wrist arthroscopy during fixation of distal radius fracture.

Future Research

Continued high quality comparative studies that assess contemporary fracture care for specific fracture patterns and the adjunctive use of arthroscopy to improve fracture reduction, treatment of associated soft tissue injury, and implant position may further clarify the role (if any) of wrist arthroscopy in the treatment of specific patterns of distal radius fracture that requires operative treatment. 

 

Additional Reference:

  1. Selles CA, Reerds STH, Roukema G, van der Vlies KH, Cleffken BI, Schep NWL. Relationship between plate removal and Soong grading following surgery for fractured distal radius. J Hand Surg Eur Vol. 2018;43(2):137-141. doi:10.1177/1753193417726636

 

 


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