The role of wrist arthroscopy following trauma

Wrist arthroscopy clearly shows lesions of carpal bone cartilages, the triangular fibrocartilage (TFC), and of carpal ligaments. Between October, 1993, and August, 1994, 37 out of 47 wrist arthroscopies were performed in the consequence of trauma. The indication was on one hand a joint check for planning further surgery, on the other hand a profound suspicion of a severe intraarticular damage, which was raised in a standardized clinical examination with localizing any points of tenderness, testing for carpal instability, and provoking carpal subluxations and pathological clicks. The standard arthroscopy ports were that between the third and fourth extensor compartment and the radial midcarpal port. Results: 12 of 37 wrist arthroscopies were done within 3 months after trauma. Two patients had fresh cartilaginous lesions, three had severe ligament damages otherwise not diagnosed, and four patients had TFC tears. In all of these nine patients arthroscopy guided the following therapy. 25 arthroscopies were done more than 3 months after trauma. 9 cartilage lesions, 3 ligament tears and 6 TFC defects were demonstrated. In 16 out of these 18 patients the arthroscopic finding was of major influence on further therapy. We conclude that wrist arthroscopy is a powerful tool in diagnosing intraarticular lesions and in planning posttraumatic wrist joint surgery. We suggest that a profound suspicion of intraarticular damage, as gained in a standardized clinical examination, should lead to wrist arthroscopy within one or two weeks after trauma.