Take Courage to Perform Open Articular Surface Repair
The authors do not explicitly point out the need for a preoperative CT scan as a prerequisite for optimum surgery planning. The reduction of the articular surface achieved with the procedure can only be documented by postoperative computed tomography and these scans can help surgeons to learn from the outcomes of the procedures they have performed.
While intraoperative fluoroscopy can control the correct angular alignment of the main fragments and the position of the locking plate after reduction, it cannot be used to verify the articular congruency and the absence of steps in the articular surface. Therefore, intra-articular inspection of the joint surface is required and the fragments that bear areas of articular surface must be reduced and secured under direct visualization. With very small fragments, this can only be achieved using thin K-wires. The best outcome requires an articular surface without any steps; this is crucial to restore good load-bearing capacity of the radiocarpal joint. Patient satisfaction despite articular surface incongruity should not blind surgeons to the fact that significantly better outcomes would have been achieved with open step-free reduction. Unfortunately, this technique greatly prolongs operating times.
Dr. med. Martin Artmann
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Bartl C, Stengel D, Bruckner T, Gebhard F and the ORCHID Study Group: The treatment of displaced intra-articular distal radius fractures in elderly patients—a randomized multi-center study (ORCHID) of open reduction and volar locking plate fixation versus closed reduction and cast immobilization. Dtsch Arztebl Int 2014; 111: 779–87 VOLLTEXT|