Abstract
Dear Editor,
We read this study with great interest. Arthroscopy in the treatment of complex distal radius fractures is common nowadays. The title of this article appears misleading because many studies have shown that arthroscopy does enhance surgical treatment of those fractures. While we agree that it is unnecessary to evacuate hematoma and small debris, we were surprised by the study protocol that the arthroscopic examination did not allow any improvements of reduction. Anatomic reduction (with no step-off or gap) was achieved in 13 out of 22 patients, which is only 59% in this case series. Lutz et al. (2011) showed severe postoperative osteoarthritis in six out of 11 patients with arbeitsgemeinschaft für osteosynthesefragen (AO) C2/C3 fractures and an intra-articular gap of 2 mm in a 9-year follow-up. In the current study, six patients in total had an intra-articular gap of either 1–2 mm or over 2 mm.
Studies have shown the benefit of arthroscopy in correcting step-off intraoperatively: Christiaens et al. (2017) showed a significantly lower residual step-off in their arthroscopy group. Abe (2014) recognized a 2 mm residual step-off in 23% of their cases when performing arthroscopy during volar plating. Long-term follow-up is definitely needed to assess degenerative changes, but arthroscopy is an easy and low-cost tool to improve intraoperative reduction.
References
Reply
Dear Editor,
We would like to thank you for the opportunity to respond to the issues raised in Dr Jann’s letter about our study (Selles et al., 2019).
The intervention in this study was arthroscopic debridement of hematoma. Additional arthroscopy reduction would not allow for proper analysis of a single intervention. With regards to functional outcome, no advantage has been found for patients treated with additional arthroscopy.
Yamazaki et al. found that arthroscopic assistance did not improve radiological and functional outcome during 12 months follow-up (Yamazaki et al., 2015). Furthermore, Ruch and Varitimidis found similar disabilities of the arm, shoulder, hand (DASH) scores (DASH score 19 vs 11 and 4.7 vs 7.9) when comparing arthroscopic to fluoroscopic reduction at 12 months and (Ruch et al., 2003; Varitimidis et al., 2008).
In our study, anatomic reduction (with no step-off or gap) was indeed only achieved in 13 out of 22 patients. When comparing patient-rated wrist evaluation (PRWE) scores at 3 months (primary outcome) for patients with anatomical reduction (n = 13) and patients without anatomical reduction (n = 9) we found no significant difference (PRWE score 22 vs 25, p = 0.7). At all other follow-up times, no significant difference was found for patients with and without anatomical reduction.
In addition, Catalano and Goldfarb examined the long-term outcome of patients with intra-articular distal radius fractures treated with open reduction and internal fixation (up to 15 years) and found no correlation between the magnitude of the residual step or gap displacement and upper-extremity function (Catalano et al., 1997; Goldfarb et al., 2006). We believe that intra-articular gap and step may not correlate strongly to functional outcomes.
References
Maasstad Hospital, Rotterdam, The Netherlands
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