778 THE JOURNAL OF BONE AND JOINT SURGERY Treatment of intra-articular fractures of the distal radius FLUOROSCOPIC OR ARTHROSCOPIC REDUCTION? S. E. Varitimidis, G. K. Basdekis, Z. H. Dailiana, M. E. Hantes, K. Bargiotas, K. Malizos From the University of Thessalia, Larissa, Greece S. E. Varitimidis, MD, Assistant Professor of Orthopaedics G. K. Basdekis, MD, Consultant Orthopaedic Surgeon Z. H. Dailiana, MD, Assistant Professor of Orthopaedics M. E. Hantes, MD, Consultant Orthopaedic Surgeon K. Bargiotas, MD, Consultant Orthopaedic Surgeon K. Malizos, MD, Professor of Orthopaedics Department of Orthopaedic Surgery University of Thessalia, 41110 Larissa, Greece. Correspondence should be sent to Professor K. Malizos; e-mail: malizos@med.uth.gr ©2008 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.90B6. 19809 $2.00 J Bone Joint Surg [Br] 2008;90-B:778-85. Received 11 June 2007; Accepted after revision 22 January 2008 In a randomised prospective study, 20 patients with intra-articular fractures of the distal radius underwent arthroscopically- and fluoroscopically-assisted reduction and external fixation plus percutaneous pinning. Another group of 20 patients with the same fracture characteristics underwent fluoroscopically-assisted reduction alone and external fixation plus percutaneous pinning. The patients were evaluated clinically and radiologically at follow-up of 24 months. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and modified Mayo wrist score were used at 3, 9, 12 and 24 months post- operatively. In the arthroscopically- and fluoroscopically-assisted group, triangular fibrocartilage complex tears were found in 12 patients (60%), complete or incomplete scapholunate ligament tears in nine (45%), and lunotriquetral ligament tears in four (20%). They were treated either arthroscopically or by open operation. Patients who underwent arthroscopically- and fluoroscopically-assisted treatment had significantly better supination, extension and flexion at all time points than those who had fluoroscopically- assisted surgery. The mean DASH scores were similar for both groups at 24 months, whereas the difference in the mean modified Mayo wrist scores remained statistically significant. Although the groups are small, it is clear that the addition of arthroscopy to the fluoroscopically-assisted treatment of intra-articular distal radius fractures improves the outcome. Better treatment of associated intra-articular injuries might also have been a reason for the improved outcome. Most fractures of the distal radius are reducible with adequate stability and can be treated by closed reduction and casting. However, frac- tures that are unstable or involve the articular surfaces can jeopardise the congruence and kin- ematics of the wrist joint. 1,2 In complex intra- articular fractures of the distal radius, arthro- scopically-assisted surgery allows more accurate reduction of the articular surface and treatment of soft-tissue injuries. 3 The place of arthroscopy in the management of these fractures, however, remains controversial. 3-5 There are no prospective studies comparing arthroscopically- and fluoroscopically-assisted techniques and only one retrospective study comparing fluoroscopic and arthroscopic reduction of fractures of the distal radius. 6 We undertook this prospective study of intra- articular fractures of the distal radius to evaluate surgical and radiological findings, functional outcomes and quality of life after reduction either by an arthroscopically- and fluoroscopi- cally-assisted technique or a fluoroscopically- assisted only technique along with stabilisation with an external fixator and possible augmenta- tion using Kirschner (K)-wires and bone graft. Patients and Methods A total of 40 consecutive patients, 23 female, 17 male, treated between July 2000 and Octo- ber 2003 were included in the study. They were assigned randomly for treatment. Each picked one of 40 sealed envelopes, 20 containing the words arthroscopically- and fluoroscopically- assisted and 20 the words fluoroscopically- assisted group. All patients had similar fracture characteris- tics and demographics (age, gender, and degree of comminution of the articular surface). Those admitted to the study had an intra- articular fracture (AO type C1, C2 or C3) 7 with a step-off or gap greater than 2 mm after closed reduction. Patients with volar lip frac- tures, open fractures, or associated upper extremity injuries were excluded. Patients with central nervous system disorders such as previ- ous stroke or cerebral palsy were also excluded.