Distal Radius Articular Surface Visualization: Comparison of Ligament-Sparing Volar and Dorsal Radiocarpal Arthrotomies for Distal Radius Fracture Reduction.

Abstract

Direct articular surface visualization may improve reduction accuracy in intra-articular distal radius fractures. A ligament-sparing volar radiocarpal arthrotomy has been described to complement the standard volar approach, but the articular surface area (SA) visualized has not been compared to the traditional dorsal radiocarpal arthrotomy. This study quantified and compared articular SA visualization through volar and dorsal ligament-sparing radiocarpal arthrotomies in a cadaveric model. Twenty-four fresh-frozen cadaveric specimens (12 matched pairs) underwent either a volar or dorsal ligament-sparing radiocarpal arthrotomy; one wrist from each pair was randomized to each approach. Visible articular SA was calculated using photogrammetric three-dimensional models created using postarthrotomy images. Radiocarpal disarticulation was performed to calculate total articular SA. Total SA percentage was compared using paired t tests. Regional articular visualization was characterized for each approach by overlay mapping. Mean percentage of SA visualization was 63.7% (range, 43.9% to 90.7%) via volar radiocarpal arthrotomy and 77.3% (range, 53.1% to 90.9%) via dorsal radiocarpal arthrotomy; the dorsal arthrotomy provided a mean increase in visualization of 13.5% (P = .008). Based on overlay mapping, the volar arthrotomy improved visualization of the volar rim, whereas dorsal arthrotomy improved visualization of the dorsal rim, dorsal-radial scaphoid facet, and dorsal-ulnar lunate facet. There was similar visualization of the central third of the radius, volar-radial scaphoid facet, and volar-ulnar lunate facet. Both volar and dorsal arthrotomies provide excellent visualization of the distal radius articular surface, although dorsal arthrotomy provided greater overall visualization. Volar arthrotomy improved exposure of the volar rim, a region commonly involved in volar rim marginal fractures and volar shear intra-articular fractures. The dorsal arthrotomy allowed regional visualization of fracture patterns involving the dorsal-radial styloid, dorsal-ulnar lunate facet, or dorsal rim articular comminution. Radiocarpal arthrotomies provide a practical direct assessment of the distal radius articular surface without additional incisions or arthroscopic resources.