Herzberg Guillaume, Burnier Marion, Ly Lyliane
Department of Orthopedics, I-Trues Wrist Surgery Unit, Clinique Parc Lyon, Stalingrad, Clinique Val Ouest, Ch Vernique, Lyon, France.
Department of Orthopedics, I-Trues Wrist Surgery Unit, Institut Main Membre Supérieur, Villeurbanne, France.
J Wrist Surg. 2021 Dec 13;11(3):224-229. doi: 10.1055/s-0041-1735980. eCollection 2022 Jun.
Arthroscopically-assisted reduction and internal fixation (AARIF) for distal radius fractures (DRF) has been extensively described. Little information is available about AARIF in AO "B3" and "C" DRF with displaced lunate facet volar rim fragment (VRF) and volar carpal subluxation. However, lunate volar rim fragment (LVRF) may be very difficult to reduce and fix under arthroscopic control using the flexor carpi radialis (FCR) or FCR extended approaches while traction is applied. The aims were to describe our surgical technique of AARIF of partial or complete DRF with VRF and provide information about how often this technique may be necessary, based on a large DRF database. The dual-window volar approach for complete articular AO C DRF with volar medial fragment was described in 2012 for performing open reduction internal fixation (ORIF). Since 2015, we have used the dual-window approach for AARIF of "B3" or "C" DRF with volar carpal subluxation. We analyzed our PAF database, searching for patients treated with AARIF in "B3" and "C" fractures. The dual-window volar approach is very useful when using AARIF for AO "B3" and "C" DRF with displaced VRF and volar carpal subluxation. The anteromedial part of the exposure allows a direct access to reduction and fixation of the LVRF under traction and arthroscopic control. Overall, 1% of all articular DRF in this series showed a displaced LVRF amenable to the dual-window volar approach. It is almost impossible to access and properly fix a VRF using traction and arthroscopic control through the FCR or FCR extended FCR approach because of the stretched flexor tendon mass. The use of the dual-window approach during AARIF of AO "B3" or "C" DRF has not previously been reported. Displaced VRF are rare whether they were part of "B3" or "C" fractures. If AARIF is chosen, we strongly recommend the use of the dual-window volar approach for AO "B3" and "C" fractures with VRF. A single anteromedial approach can also be used for isolated "B3" anteromedial DRF.
桡骨远端骨折（DRF）的关节镜辅助复位与内固定（AARIF）已有广泛报道。关于AO“B3”型和“C”型DRF合并月骨小关节掌侧缘骨折块（VRF）及腕掌侧半脱位的AARIF信息较少。然而，在应用牵引的同时，通过桡侧腕屈肌（FCR）或FCR延长入路在关节镜控制下复位和固定月骨掌侧缘骨折块（LVRF）可能非常困难。本研究旨在描述我们对合并VRF的部分或完全DRF进行AARIF的手术技术，并基于一个大型DRF数据库提供该技术所需频率的相关信息。2012年描述了用于伴有掌侧内侧骨折块的完全关节内AO C型DRF切开复位内固定（ORIF）的双窗口掌侧入路。自2015年以来，我们已将双窗口入路用于伴有腕掌侧半脱位的“B3”型或“C”型DRF的AARIF。我们分析了我们的PAF数据库，查找接受“AARIF”治疗的“B3”型和“C”型骨折患者。对于伴有移位VRF及腕掌侧半脱位的AO“B3”型和“C”型DRF，在进行AARIF时，双窗口掌侧入路非常有用。暴露的前内侧部分允许在牵引和关节镜控制下直接进行LVRF的复位和固定。总体而言，本系列中所有关节内DRF的1%显示有适合双窗口掌侧入路的移位LVRF。由于屈肌腱团块拉伸，通过FCR或FCR延长FCR入路利用牵引和关节镜控制来显露和妥善固定VRF几乎是不可能的。AO“B3”型或“C”型DRF的AARIF期间使用双窗口入路此前未见报道。移位的VRF无论是“B3”型还是“C”型骨折的一部分都很罕见。如果选择AARIF，我们强烈推荐对伴有VRF的AO“B3”型和“C”型骨折使用双窗口掌侧入路。单一的前内侧入路也可用于孤立的“B3”型前内侧DRF。
