Dry wrist arthroscopy.

A RTHROSCOPY AFFORDS SURGEONS the ability to evaluate and treat intra-articular pathology in a direct, minimally invasive manner. Wrist arthroscopy has transformed the way physicians approach wrist disorders. The equipment and principles used are based on the techniques of large joint arthroscopy. Using fluid for articular distention and visualization has traditionally been thought of as an essential component of this procedure. This classic (wet) wrist arthroscopy technique was thought necessary to adequately debride bone and soft tissues under direct visualization. Use of fluid instilled either via gravity or pump systems is not without complications, particularly in small joints. This effect can hinder concomitant open surgery being performed owing to disruption of anatomical soft tissue planes. To facilitate distention, arthroscopists have typically limited the size of portals. This limits fluid losses but minimizes portal size and thus instrument size. Recently, this fluid-based paradigm has been challenged. So-called “dry” wrist arthroscopy (DWA) can circumvent the aforementioned problems while still allowing adequate visualization for each procedure. It does so by allowing larger portals and thus larger instruments. Fluid can be problematic when reducing intra-articular fractures. Fluid can displace fragments and also track into the fracture site, interfering with reduction. The dry technique facilitates the combination of open procedures with arthroscopic visualization, allowing for more precise fracture reduction. The absence of fluid distention facilitates soft tissue dissection and easier hardware placement.