Abstract：Objective To explore the clinical features of complex distal radius fractures and the rationality and advantages of repairing treatment by wrist arthroscopy.Methods Clinical data of 16 patients with complex distal radius fractures involving articular surface destruction and surrounding tissue injuries from April 2014 to May 2016 were collected, including 9 males and 7 females, average age (44.1±17.4) years, range 17-74 years. According to AO/OTA classification, B2 type was in 2 patients, B3 type in 3 patients, C1 type in 3 patients, C2 type in 4 patients and C3 type in 4 patients. The minimally invasive incision combined with wrist arthroscopy was used to assist the internal fixation of patients, including the reduction of joint internal and external fracture, the repair of triangular fibrocartilage complex and intercarpal ligament, the retaining of the plate on pronator quadratus etc. The reduction of fracture, the debridement of cartilage and the treatment of microfractures at defects were adjusted during surgery according to the condition of the flatness of joint plane in wrist arthroscope and the matching of distal radioulnar joint. And 2 weeks after surgery, the healing situation and wrist soft tissue would be evaluated by wound healing. Three months later, the situation would be assessed by the fracture reduction, healing, the arrangement between carpal bones, the matching of distal radioulnar joint, internal fixation. In addition to observing the above-mentioned indicators, the range of forearm rotation, grip and disabilites of the arm, shoulder and hand(DASH) were evaluated after 12 months of the procedures.Results All 16 patients were followed up for at least 1 year, with an average of 15-72 (32.1±9.2) months. And 2 weeks after operation, the incision healed well without infection or necrosis of soft tissue and complications of blood vessel and nerve. Three months later, radiographic image showed that fractures were effectively healed without loss of fracture reduction, as well as the arrangement between carpal bones and the matching of distal radioulnar joint was good without obvious pain in the wrist. Only a Kirschner wire loosened in a patient's wrist dorsal and it was removed after 2.5 months of the surgery, while the rest of Kirschner wires fixed well, and during 12 months of follow-up, the patient's wrist, presented moderate pain, decreased grip strength and significantly hypofunction. Radiographic image suggested that local dent of articular surface had a change in traumatic arthritis, but there was no obvious pain in the wrists of the rest 15 patients, and their carpal bones arrangement and distal radioulnar joint matched well, without osteoarthritis performance by radiographic imaging, as well as wrist flexion and extension, forearm rotation range and grip strength performed well, with DASH upper limb function average score being (11.3±3.5) points.Conclusions Complex distal radius fracture is characterized by articular surface and other bone structure with one or several surrounding tissue serious injury caused by high violence. Operative treatment assisted by wrist arthroscopy can make a minimally invasive, comprehensive and accurate diagnosis and treatment of this disease by alleviating damaged tissue, reducing complications and improving clinical efficacy, thereby having advantages in the treatment of complex distal radius fractures.
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2018, Vol. 23 
