Treatment of AO-C distal radius fractures with volar minimally invasive approach combined with wrist arthroscopy

doi:10.3877/cma.j.issn.1674-134X.2023.04.018

Abstract

Abstract:

Objective

To investigate the clinical efficiency of the treatment of AO-C distal radius fracture with volar minimally invasive approach combined with arthroscopic articular surface reduction plate internal fixation.

Methods

Patients with AO type C distal radius fracture between February 2018 and September 2020 were retrospectively analyzed. The patients were treated with arthroscopic assisted mini- invasive approach in the small incision group(25 patients). The length of incision, operation time, intraoperative blood loss, visual analogue scale(VAS )score of wrist pain on the second day postoperative and the scar of the incision were documented and compared with a traditional Henry approach (traditional group, 17 patients) by independent sample t test and chi-square test were used for comparative analysis.

Results

The patients of small incision group were assessed postoperatively with the average follow-up time of (12±6) months, and the traditional group was followed up for(13±6) months. The operation time in the small incision group was longer than that in the traditional group(t=6.77, P<0.05). Compared to the traditional group, the length of incisions was shorter in the small incision group(t=11.72); there was less blood loss during operation in the small incision group(t=10.16); the Mayo wrist score was higher in the small incision group (t=3.57), and the early postoperative pain VAS score was lower in the small incision group(t=2.61); the Stony Brook scar evaluation scale (SBSES) evaluated the the incision scar was better in the small incision group(t=3.75); the differences were statistically significant (all P<0.05).

Conclusion

Compared with the traditional Henry approach, arthroscopy combined with volar minimally invasive approach internal fixation for the treatment of AO-C distal radius fracture may provide a sufficient exposure of joint, with less blood loss, slight early postoperative pain and less incision scar, but the operation time is longer.

Key words: Radius fracture, Arthroscopy, Fracture fixation, Internal

Weiya Qi, Jie Fang, Heng Wu, Bo Liu. Treatment of AO-C distal radius fractures with volar minimally invasive approach combined with wrist arthroscopy[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(04): 577-582.

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URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-134X.2023.04.018

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2023/V17/I04/577

Figures/Tables 3

Figure 1 The pre-and post-operative images, intraoperative wrist condition and follow-up information of the patient with distal radius fracture of the right wrist. A is anteroposterior and lateral position X-ray images and CT images of the right wrist, showing obvious displacement of articular surface fracture and AO classification is type C; B is reduction under arthroscope; C is the small incision immediately after surgery, one centimeter of length; D is anteroposterior and lateral positions X-ray and CT images of right wrist after removal of internal fixation, showing the articular surface recovered well; E shows functional recovery of the patient at last follow-up, Mayo score 95; F shows scar in the surgical area, the SBSES score is four

Figure 2 The pre-and post-operative images, intraoperative wrist condition and follow-up information of the patient with distal radius fracture of the right wrist.A is anteroposterior and lateral position X-ray images and CT images of the right wrist, showing obvious displacement of articular surface fracture, and AO classification is type C; B is the small incision immediately after surgery, 1.5 cm in length; C is reduction under arthroscope, showing fracture end alignment is good, step distance is less than two millimeters; D is anteroposterior and lateral positions X-ray and CT images of right wrist at 17 months after operation, showing the fracture end healed well, the articular surface recovered well, and there is no obvious step; E is scar of the surgical area and functional recovery at the 17 months after surgery, Mayo score is 90 and SBSES score is four

Table 1 The surgical datas and scores were compared between the small incision group and the traditional group

组别Groups	例数Case number	手术时间(min) Operation time	切口长度(cm) Length of incisions	出血量(ml) Blood loss	Mayo腕关节评分Mayo wrist score	VAS评分	SBSES评分
小切口组Small incision group	25	109.71±6.50	1.50±0.16	15.37±3.31	92.68±5.02	1.34±1.30	3.22±1.00
传统组Ttraditional group	17	65.00±27.74	5.42±1.45	34.63±7.61	85.97±8.15	2.65±1.61	4.15±0.82
t值		6.77	11.72	10.16	3.57	2.61	3.75
P值		<0.001	<0.001	<0.001	<0.01	0.013	<0.01

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