| Objective:1.To explore the possibility to treat the distal radius fractures with the use of arthroscopy according to the Doi classification.2.To discuss which types of Doi classification fractures are suitable for arthroscopic assistant reduction.Methods:From August 2014 to August 2018,79 cases of distal radius fractures were collected in the First Affiliated Hospital of Dalian Medical Universit,including 21 males and 58 females,agingfrom 28 to 81 years oldand the mean age is 57.1 years old.Standard anterioposterior and lateral X-rays and CT scans of the wrist were performed to confirm the Doi classification of the distal radius fracture preoperatively.All patients underwent Henry approach.A distal radius anatomical plate was used after reduction.When the reduction resullts were confirmed by X-ray during the operation,the arthroscopy was performed to investigate the articular surface.The cases that the articular surfaces separated higher than 1mm and confirmed episomes in the articular cavity were included.Then the articular surfaces were re-reducted and the episomes were removed under the arthroscopy.The wrist active movement and grip strength were examinedduring 6 to 14 months postoperatively and the Gartland-Werley scoring criteria was used to evaluate the treatment.Results:1.Among 79 cases of intra-articular fractures of the distal radius,60 cases could be classified depending on Doi classification accurately.The data showed bellow :there were 11 cases of 2 partial horizontal type,13 cases of 2 partial vertical type,2cases of 2 partial dorsal margin type,12 cases of three-part type and 22 cases of four-part type.Another 19 patients could not be classified depending Doiclassification accurately,which meantthe Doi classification had its limitations.Among19 cases,18 of them showed that the fracture line started from the sigmod,went through the central area of the menstrual fossa,then ended at the Lister nodule on CT scans.We named this fracture type as 2 partial "dorsl-ulnar type" of Doi classification.The rest one showed that the fracture line started from the sigmod,went through the central area of the menstrual fossa,then ended at the middle of the volar radius on CT scans.We named this kind of fracture type as 2 partial "ulnar volar type" of Doi classification classified.As we added two types of fracture,we named it as "Doi modified type of distal radius fracture"(Figure 2).2.There were 21 casese that the articular surfaces separated higher than 1mm totally.According to the Doi classification,there were 2 cases of 2 partial horizontal type,4cases of 3 partial fractures,8 cases of 4 partial fracturesand 6 cases of 2 parts of the ulnar side type.Among them,the fractures that were re-reducted were located on the lunate fossa in 20 cases,on the scaphoid fossa in 1 case and on the central depression in 1case.The screws inserted into the joint in 7 cases.Episomes were found in 3 cases and 2 of them demonstrated reversed episomes.All patients were followed up in 6-13 months.Three of them had removed plate in 11-14 months.The final follow-up results showed: wrist flexion range: 54-69 °,average 61 °;extension range: 50-73 °,average 60 °;grip strength was 63%-87% compared to the opposite extreme,average80%.According to the Gartland-Werley scoring criteria,13 cases were excellent,7cases were good,and 1 case was medium.The excellent and good rate was 95.3%.No casesdemonstrated nerve compression.Conclusion:1.We classified the cases of intra-articular fractures of the distal radius with Doi classification,and found the limitations of Doi classification.We added two types of fractures and modified the Doi classification.2.We believe that the indications using arthroscopic assistant reduction in intra-articular fractures of the distal radius are:a.2 partial horizontal type b.2 partial "dorsl-ulnar type" of Doi classification,three-part,four-part fractures,c.CT scan shows the presence of episomes in the joint cavity preoperatively. |
