Fig. 16.1 This chapter will not reiterate the excellent work done by Diego Fernandez and Jesse Jupiter on extra-articular osteotomies. First of all, they have covered the topic extensively, and secondly, now extra-articular malunions are rare. Conversely, intra-articular disasters are more common due to the misconception that fixing distal radius fractures is easy. Major derangement of the cartilage of the carpals due to a combination of uncorrected step-offs and screw penetration is shown here.
Fig. 16.2 This chapter focuses on three issues that benefit enormously from arthroscopy and that may go unaddressed if only an extra-articular osteotomy is performed: ulnar styloid impaction, lack of supination, and intra-articular scarring blocking wrist range of motion. These can occur in combination or in isolation. The following case contains all three issues. This 71-year-old woman complained of diffuse wrist soreness 15 months after sustaining an extra-articular fracture. This had been treated elsewhere in a cast and healed with relatively good alignment.
Fig. 16.3 Despite an overall maintenance of alignment, she complained of pain and both limited wrist extension and supination. She was depressed because this injury had interfered markedly with her life. A plan was made to increase her wrist motion, release intra-articular adhesions, and address any other issues that may be encountered.
Fig. 16.4 Arthroscopy after a fracture is more difficult than a standard arthroscopy. The scar tissue from the injury makes it difficult to palpate the portals, and the joint will not yield even with 15-kg of traction. (a) If one attempts to perform a standard arthroscopy, this might break the scope, cause chondral damage, or create a bone hole. (b) The typical first sight inside the joint—a red picture.
Fig. 16.5 The trick is to “sneak” the scope into the joint by going dorsal to the radius rim and trying to find the shaver inserted from 6R. (a) Once triangulation has been achieved, the scar tissue is removed along with the scarred dorsal capsule until a working space is created. (b) Triangulation has been successful.
