Complications

We have experienced no serious complications in our technique of arthroscopically assisted reduction and percutaneous fixation. The most common complication in our experience has been reoperation for hardware removal, which occurred in less than 5% of patients. The most common disadvantages of other techniques are listed in Table 43-2.

Table 43-2 Alternative Management Strategies

Type of Management Advantages

Disadvantages

Comments

Arthroscopically assisted, percutaneous reduction and fixation

Nonoperative

Closed reduction, percutaneous pin fixation

External fixation

Open reduction and internal fixation

Secure fixation; minimal secondary injury; hardware not exposed in soft tissue No surgical risk

Minimal secondary injury; reduced surgical risk

Anatomic reduction; secure fixation

Anatomic reduction; secure fixation

Authors' preferred method (when appropriate)

For displaced intraarticular fracture, long-term osteoarthritis; often suboptimal results including pain and stiffness of the joint Tenuous fixation; rehabilitation delayed until pins removed; risks are superficial and deep pin tract infection Technically demanding; greater interference with patient's activities of daily living Extensive soft tissue dissection; greater operative exposure increases postoperative swelling and joint stiffness

Reserved for open injuries

Risks include increased chance of infection as well as injury to the sensory nerve

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