Arthroscopic Fracture Treatment

Arthroscopic fracture treatment is a modern surgical technique for repairing fractures extending into joint surfaces through small incisions using a camera. Compared to traditional open surgery, it causes less soft tissue damage, less pain, and faster recovery. It is preferred especially in fractures of the wrist (distal radius), knee (tibial plateau), ankle, and elbow joints. The main advantage is the ability to reposition the joint surface with millimeter precision, reducing the risk of future arthritis.

Symptoms

Fractures extending into joint surfaces typically present with:

• Sudden joint pain after trauma, worsening with movement
• Visible joint swelling and hematoma
• Severely restricted joint range of motion
• Difficulty bearing weight or using the limb
• In some cases, visible deformity of the joint

Diagnostic Methods

Detailed clinical examination is the most important first step. X-rays show the presence and general pattern of the fracture. Computed tomography (CT) is the gold standard for assessing intra-articular fractures; joint surface step-offs and fragment positions are clearly visualized. MRI may be needed to evaluate concomitant soft tissue injuries (cartilage, ligaments).

Treatment Approach

Non-Surgical Treatments

Non-displaced fractures with less than 2 mm of articular step-off may be managed conservatively. This involves immobilization with cast or splint followed by controlled physical therapy. However, surgical repair is the gold standard for most intra-articular fractures since a malunited articular surface leads to long-term arthritis.

Surgical Treatment

The arthroscopic technique involves inserting a camera and micro instruments through 4-5 mm portals into the joint, reducing the fracture under direct visualization, and stabilizing it with percutaneous screws or plates. During surgery, the joint surface is repositioned with millimeter precision under direct visualization — impossible with closed methods. Accompanying cartilage or ligament injuries can be repaired in the same session.

Surgical Process

Surgery is typically performed under regional or general anesthesia and lasts 1-2 hours on average. Fluid is infused into the joint to create the visualization field; the camera is used to assess internal structures; fracture fragments are repositioned and fixed with small screws through the skin.

Hospital Stay

Typically same-day discharge or 1 overnight hospital stay is sufficient. Wound care and initial dressing are done before discharge.

Recovery Process

• Weeks 1-2: Swelling and pain control, limited immobilization, suture removal
• Weeks 2-6: Start of joint range of motion exercises, physical therapy
• Weeks 6-12: Strengthening program, gradual weight bearing
• Months 3-6: Return to full activity and sports

Return to Work

Return to desk work averages 2-3 weeks; physical workers may need 6-12 weeks. Return to sports typically takes 3-6 months.

Potential Complications

As with any surgery, rare risks include infection, nerve or vascular injury, and thrombosis. The most important long-term complication in intra-articular fractures is early arthritis (post-traumatic osteoarthritis); arthroscopic repair reduces this risk.