Arthroscopic Treatment of Distal Radius Fractures

Distal radius fracture (DRF) is one of the most common traumatic events for the hand surgeon to treat. Numerous surgical procedures have been described for this fracture (Ruch et al., 2004); however, the ideal method of surgical management is still controversial. The latest development of a volar locking plate fixation markedly changed the treatment of DRF (Chen & Jupiter, 2007; Chung et al., 2006). Volar locking plate fixation creates a more rigid mechanical construct and allows early rehabilitation that can be initiated with the goal of an improved functional outcome; therefore, volar locking plate fixation currently has widespread popularity, even for dorsally displaced intraarticular fracture (Orbay & Fernandez, 2002; Willis et al., 2006). The functional outcome of the treatment of DRF is considered to be affected by extraarticular alignment, anatomical reduction of the articular surface, intraarticular soft tissue injuries and postoperative complications. Wrist arthroscopy is currently recognized as an important adjunctive procedure in the management of DRF (Doi et al., 1999; Freeland & Geissler, 2000; Ruch et al., 2004). This is because arthroscopically assisted reduction and internal fixation of DRF cause minimal surgical intervention and provide not only excellent visualization of the joint surface for anatomical restoration of articular fragments but evaluate and treat intraarticular soft tissue injuries. Although it is better used in conjunction with percutaneous pinning and external fixation, wrist arthroscopy becomes problematic when plate fixation is performed because vertical traction has to be both applied and released during surgery; therefore, a plate presetting arthroscopic reduction technique (PART) using a volar locking plate has been developed, that can simplify the combination of plating and arthroscopy (Abe et al., 2008). PART can also be performed with minimal skin incision and is less invasive. This chapter will describe the procedure of PART and its effectiveness for the treatment of DRF.