2004, Number 2
<< Back Next >>
Acta Ortop Mex 2004; 18 (2)
Associated lesions to the radius distal fractures. Arthroscopic diagnosis
Blanco BP, Hernández CV, Ciénega RMA, González PCE
Language: Spanish
References: 25
Page: 44-49
PDF size: 87.27 Kb.
ABSTRACT
Introduction. When facing a radius distal fracture, the proper restitution of
the osseous anatomy is essential to minimize complications; however, there are
added lesions that sometimes are not recognized or diagnosed and so they are
not treated. This lesions become wrist a dysfunctional joint. Our study objective
is to establish an arthroscopic diagnosis of inter-joint lesions that are
associated to radius distal fractures that were already surgically treated and
with rehabilitation and that, as a consequence, present pain and functional
limitation. We also try to verify if data that may suggest associated lesions
can be observed.
Material and methods. We performed an observational,
prospective, transversal, descriptive, and open study from January to December
2003. We practiced twenty wrist arthroscopies to twenty patients that had
suffered from radius distal fractures. They were treated through close or
open reduction and fracture fixing with nails, external fixer, T-plaque
or a combination of these ones with or without osseous grafting. With the
arthroscopic procedure FCT lesions were intentionally searched, which were
classified according to Palmer, condral lesions according to Outerbridge’s
types, and partial or complete interosseous ligaments.
Results. The results
show that all of the patients (100%) suffered from some kind of associated
lesions; in every case we observed the building-up of inter-joint fibrous
membrane and some grade of fibrosis. The condral lesion was present in 85%
of the patients, being more frequent on the radius joint surface (60%). In
12 patients (60%) we found triangular fibrocartilage lesion, specially in
its cubital insertion.
Interosseous ligament lesions were observed in 25% of the patients.
Conclusions.
In all of the cases, radius distal fracture was accompanied by associated
lesions, being condral lesion the most frequent one, followed by FCT lesions,
and interosseous ligament lesions in third place. We found a relationship
between the type of fracture and the type of associated lesion: there was
a more serious condral lesion in joint fractures and lighter in interosseous
ligaments. This is the contrary of the facts observed in extra-joint
fractures. The initial X-rays happened to be predictive of associated
lesions.
REFERENCES
Andrews JR, Timmerman LA: Artroscopía, Madrid, España Marban, 2001: 193-205.
Berger RA: The anatomy of the ligaments of the wrist and distal radioulnar joints. Clinic Orthop 2001; 1(383): 32-40.
Cober SR, Trumble TE: Arthroscopic repair of triangular fibrocartilage complex injuries. Orthop Clin North Am 2001; 32(2): 279-294.
Corso SJ, Savione FH, Geissler WB, Whipple TL, Jiminez W, Jenkis N: Arthroscopic repair of peripheral avulsions of the triangular fibrocartilage complex of the wrist: a multicenter study. Arthroscopy 1997; 13(1): 78-84.
De Araujo W, Poehling GG, Kuzma GR: New Tuohy needle technique for triangular fibrocartilage complex repair. Arthroscopy 1996; 12(6): 699-703.
Gelberman RH: Master en cirugía de muñeca, Madrid, España Editorial Marban, 1999: 21-45.
Kapandji AI. Fisiología Articular, Madrid, España Panamericana, 1998; Vol 1: 154-174.
Lindau T, Adlercreutz C, Aspenberg P: Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg Am 2000; 25(3): 464-468.
Merle M, Dautel G, Loda G: Mano traumática, Masson, 1995: 309-320 y 363-379.
Müller ME, Allgöwer M, Schneider R: Manual de osteosíntesis, Springer-Verlag Ibérica. 1993: 118-135 y 476-484.
Muñoz GJ: Atlas de mediciones radiográficas en Ortopedia y Traumatología, McGraw-Hill Interamericana, 1999: 113-120.
Nagle DJ: Triangular fibrocartilage complex tears in the athlete. Clin Sports Med 2001; 20(1): 155-166.
Netter Frank H: Anatomía y Fisiología del Sistema Musculoesquelético, Barcelona, Masson-Salud, 1998: 55-73.
North ER, Meyers S: Wrist injuries: correlation of clinical and arthroscopic finding. J Hand Surg 1990; 15(6): 915-920.
O’Connor R: Arthroscopic surgery, 2a. ed, JB Lippincott Company. 1992: 649-656.
Palmer AK, Werner FW: The triangular fibrocartilage complex of the wrist anatomy and function. J Hand Surg 1981; 6(2): 153-162.
Palmer AK: Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14(4): 594-606.
Richards RS, Bennett JD, Roth JH, Milne K Jr: Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am 1997; 22(5): 772-776.
Sagerman SD, Short W: Arthroscopic repair of radial-sided triangular fibrocartilage complex tears. Arthroscopy 1996; 12(3): 339-342.
Schatzker JT: Tratamiento quirúrgico de las fracturas. Panamericana, 1998: 145-160.
Shih JT, Lee HM, Tan CM: Early isolated triangular fibrocartilage complex tears: Management by arthroscopic repair. J Trauma 2000; 53(5): 922-927.
Trumble ET, Gilbert M, Vedder N: Arthroscopic repair of the triangular fibrocartilage complex tears. Arthroscopy 1996; 12(5): 588-597.
Ward LD, Ambrose CG, Masson MV, Levaro F: The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability. J Hand Surg 2000; 25(2): 341-351.
Westkaemper JG, Mitsionis G, Giannakopoulos PN, Sotereanos DG: Wrist arthroscopy for the treatment of ligament and triangular fibrocartilage complex injuries. Arthroscopy 1998; 14(5): 479-483.
Zarins B, Caugat R: Principios de Artroscopía y Cirugía Artroscópica, Springer-Verlag Ibérica, 1993: 303-348.