Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
JM Cognet
SOS Mains Champagne Ardenne
Polyclinique Saint Andr, 5 Boulevard de la paix
51100 REIMS, France http://www.mainetpoignet.com
Lindau T, Arner M, Hagberg L : Intraarticular lesions in distal fractures of the radius in young adults a descriptive arthroscopic study in 50 patients.
J Hand Surg (Br), 1997, 22, 638-643
Freeland AE, Geissler WB The arthroscopic management of intra-articular distal radius fractures. Hand Surg. 2000, 5(2), 93-102.
Ruch DS, Vallee J, Poehling GG, Paterson Smith B, Kuzma GR. Arthroscopic reduction versus fluoroscopic reduction in the management of intraarticular distal radius fracture. J arthroscopic related surgery, 2004, 3, 225-230
Edwards CC, Haraszti CJ, McGillivary GR, Gutow AP. Intra-articular distal radius fractures : arthroscopic assessment of radiographically assisted
reduction. J Hand Surg [Am], 2001, 26(6), 1036-1041
Adolfsson L, Jrgsholm P. arthroscopically-assisted reduction of intra-articular fractures of the distal radius. J Hand Surg [Br], 1998, 23(3), 391-395
Mathoulin C, Sbihi A, Panciera P. intrt de larthroscopie du poignet dans le traitement des fractures articulaires du infrieur du radius :
propos de 27 cas. Chir Main. 2001, 20(5), 342-50
Cognet JM, Bonnomet F, Ehlinger M, Dujardin C, Kempf JF, Simon P. Contrle arthroscopique dans le traitement des fractures articulaires du
radius distal : propos de 16 cas. Rev chir Orthop. 2003, 89, 515-523
Hattori Y, Doi K, Estrella EP, Chen G. Arthroscopically assisted reduction with volar plating or external fixation for displaced intra-articular
fractures of the distal radius in the elderly patients. Hand Surg. 2007;12(1):1-12
del Pial F. Dry arthroscopy of the wrist : its role in the management of articular distal radius fracture. Scand J Surg. 2008;97(4):298-304
Cognet JM, Martinache X, Mathoulin C. Arthroscopic management of intra-articular fractures of the distal radius. Chir Main. 2008 Sep;27(4):171-9
X-Ray ?
TDM ?
Fluoroscopy ?
Using standard
X-Ray, what
can we see ?
Front view
Lateral view
TDM ?
of your reduction
Fluoroscopy alone cant show the state of the reduction
radius
most of the time we use an anterior locking plate, with anterior approach
Plate is fixed on the anterior side of the wrist using a non locking screw
Partial synthesis of the distal part of the radius is done using one or two locking
screws
Evacuation of hemarthrosis is the first thing to do to evaluate the reduction of the
fracture
A needle is introduced in the radio-carpal articulation : this needle gives you information about
the direction of the K-wire you need to fix the fracture
The impacted part of the articular surface is reduced using the hook or a K-wire (used as a
joystick)
Once the reduction has been achieved, push the K-wire (with a motor) to fix it
Last step is the osteosynthesis of the distal part of the radius with locking screws
b
c
b
c
c
a
d
d
b
a
a
b
c c
b
c
a
90 mn = 30 mn X 3
First 30 mn : osteosynthesis and partial reduction
Second 30 mn : arthroscopic control and articular reduction
Third 30 mn : last screws and treatment of associated lesions
First Step
Second Step
Arthroscopic control
Third Step
Arthroscopic Assessment of Intra-Articular Distal Radius Fractures After Open Reduction and Internal Fixation From a Volar Approach
Kevin Lutsky, Martin I. Boyer, Jennifer A. Steffen, Charles A. Goldfarb Journal of Hand Surgery April 2008 (Vol. 33, Issue 4, Pages 476-484)
Associated injuries
Between 30 and 80%
Cartilaginous lesions (radius, capitatum)
Ligamentous injuries (scapho-lunate, luno-triquetral,
TFCC)
orthopaedic treatment
shrinkage
orthopaedic treatment
shrinkage
Geissler IV
orthopaedic treatment
shrinkage
Conclusion
Arthroscopy should be a routine procedure for the
treatment of an intra-articular fracture of the distal radius