Arthroscopic Treatment for Intra-articular Distal Radius Malunion: The "4-Step" Procedure

Distal radius fractures have a high incidence of unsatisfactory functional outcomes when not treated appropriately, with malunion being the most common complication. This occurs in 5% to 70% of cases of fractures treated nonoperatively and can impair functionality, strength, and mobility, as well as lead to early articular degeneration if displacement exceeds 2 mm. Surgical treatment through osteotomies aims to correct deformities and restore joint function. The surgical technique presented in this study involves 4 main steps: preoperative arthroscopy to evaluate the joint and rule out other lesions, extra- and intra-articular osteotomies to realign bone fragments following the original fracture line, and definitive fixation with anatomic volar plates that allow early mobilization. Arthroscopy improves visualization and reduces soft tissue damage compared with open procedures, making it a key factor for the procedure's success. Early treatment (within 8 wk) is critical to facilitate correction. Indications for intra-articular osteotomy include active patients with articular step-offs greater than 2 mm, while contraindications include advanced joint degeneration or irreducible midcarpal instability. Potential complications include nerve or tendon injuries, joint stiffness, and issues with fixation materials. Due to its complexity, this surgery requires advanced expertise in arthroscopic techniques and osteotomies.