Sports surgery – wrist fractures arthroscopy

Definition of wrist fractures:

In sports surgery, articular fractures of the distal radius (wrist fractures) are particularly frequent; these sports injuries can be associated with other severe ligamental lesions at the wrist and pose a risk of precocious osteoarthritis of the wrist if the fracture is not anatomically reduced.
In this context of sports surgery, for a traumatic pathology that is particularly frequent and affects young and active individuals, the benefits of specialized arthroscopic wrist surgery are clear.

In sports surgery, the fracture of the wrist is found in athletes after a violent fall, particularly at football or rugby.Among the fracture-prone sports are also motorsports, cycling, motorcycling, horse-riding…

 

Video of arthroscopic wrist fracture surgery:

Sports surgery operation – Video showing arthroscopic surgery on wrist fracture / Toulouse specialist

 

Diagnosis of wrist fractures:

Shown below is a particularly comminuted fracture of the wrist joint seen frontally and laterally, with a forward avulsion of a joint fragment.

Pre-operative x-ray of an articular wrist fracture (front), ToulousePre-operative x-ray of an articular wrist fracture (Side), Toulouse

 

Surgical treatment for wrist fractures:

The procedure consists in reducing and fixing the wrist fracture through an anterior incision at the wrist measuring less than 5 cm; once reduction is achieved, the osteosynthesis plate is positioned under the pronator quadratus, which doesn’t need to be incised.

Wrist fracture, extra-short titanium anatomical osteosynthesis plate, ToulouseWrist fracture, titanium osteosynthesis plate with its screws locked, Toulouse

 

Extra-articular fracture reduction is then confirmed, first at fluoroscopy.
Once satisfactory reduction of the wrist fracture is obtained, the assessment of the lesions to the wrist joints can begin by arthroscopy through the 3,4 optical radiocarpal portal.

Here we can see bleeding inside the wrist joint caused by the fracture; the blood can be sucked out with a needle to clarify the articular fluid and improve visibility. Similarly, blood clots can be removed with a needle or shaver; lesion assessment can then begin.
First the quality of the joint fracture reduction is verified, then the integrity of the TFCC and scapholunate ligaments.

 

Wrist fracture, anterior portal less than 5-cm wide, ToulouseWrist arthroscopy, TFCC ligament, Toulouse

 

The surgeon exposts a partial radial detachment of the central part of the TFCC ligament related to the fracture line ending at this location.
One can note the integrity of the scapholunate ligament and of the lateral radioscaphoid ligament.

Once arthroscopic evaluation is complete, the 1-mm arthroscopic incisions are left to heal by secondary intention, the anterior surgical incision can then be closed with absorble stitches.
This x-ray shows the post-operative result.

 

Wrist arthroscopy, fracture site, ToulousePost-operative x-ray, Toulouse

 

Recovery after wrist fracture surgery

A removable wrist splint will be necessary for 3 weeks, daily life movements can resume after 3 weeks, forceful and resistive movements can resume after 6 to 8 weeks.

Removable post-operative splint following wrist fracture, ToulouseAnterior scar at 1 month, less than 5-cm-wide, Toulouse

 

Dorsal scar from wrist arthroscopy, these are usually invisible at 1 month.