To Scope or Not to Scope During Wrist ORIF

A robust RCT says skip the scope, and we agree

To Scope or Not to Scope During Wrist ORIF

What’s the Claim?

A well-designed randomized clinical trial compared ORIF of wrist fractures with volar locking plates performed with and without wrist arthroscopy and found that adding arthroscopy to the ORIF resulted in:

  • No improvement in any patient-reported outcomes scores at any time point out to a year (PRWE, DASH, SF-12), nor in terms of ROM or strength, compared to surgery performed without arthroscopy
  • No increase in the percentage of patients who achieved the minimum clinically important difference on the primary outcomes tool used (the PRWE); about 85% of patients in both groups improved by a clinically important amount
  • No advantage in terms of residual step-offs identified by CT scans compared to surgery performed without adjuvant arthroscopy

Adding arthroscopy resulted in the more-frequent identification of “associated lesions” — mainly scapholunate ligament and TFCC tears — resulting in treatments that increased surgical time by about 20 minutes and increased the time patients spent in splints and slings. But all this extra care was not reflected in any discernible differences in pain or function as noted above.

How’s It Stack Up?