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.
Video of arthroscopic wrist fracture surgery:
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.
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.
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.
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.
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.