Emily A Lalone1, Vaishnav Rajgopal2, James Roth3, Ruby Grewal3, Joy C MacDermid4. 1. Clinical Research Laboratories, Hand Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada ; School of Rehabilitation Sciences, McMaster University, Hamilton, ON Canada. 2. Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON Canada ; Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada. 3. Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON Canada ; Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada ; Clinical Research Laboratories, Hand Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada. 4. Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada ; Clinical Research Laboratories, Hand Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada ; School of Rehabilitation Sciences, McMaster University, Hamilton, ON Canada ; The Lawson Health Research Institute, P.O. Box 5777, London, ON N6A 4L6 Canada.
Abstract
BACKGROUND: The purpose of this study was to describe the outcomes of a series of patients followed prospectively after intra-articular distal radius fractures. METHODS:One hundred forty-eight patients with intra-articular fractures (mean age, 47 years; age range, 44-54 years; gender distribution, 60 males and 88 females) were treated with cast only, arthroscopy/closed reduction plus pins, arthroscopy/closed reduction with external fixation, open reduction and internal fixation (ORIF) alone, and ORIF with external fixation according to surgeon preference and fracture characteristics. The 1-year outcomes across the groups were measured radiographically (n = 148) and functionally (n = 113; 1-year Wrist Outcome Measure score, Grip Strength, SF-36, and PRWE scores). RESULTS: Radiographically, the groups had statistically significant differences in radial inclination, volar tilt, intra-articular step-off, and radial shortening in the pre-treatment X-rays. However, following treatment, treatment groups demonstrated no difference statistically in their follow-up radiographic measures. One-year PRWE scores were found to be statistically different across groups. Across groups, the ORIF-alone treatment group had the highest PRWE score reflecting greatest amount of pain and disability. One-year wrist outcome measure scores and grip strength scores were also found to be significantly different across treatment groups. The general health status as measured by the SF-36 was not found to be different across treatment groups. CONCLUSIONS: These findings are consistent with treatment by indication; suboptimal ORIF outcomes may reflect older practice patterns with dorsal plating. A randomized control trial that compares treatments controlling for fracture severity and studies that develop formal clinical prediction rules for treatment assignment are needed.
RCT Entities:
BACKGROUND: The purpose of this study was to describe the outcomes of a series of patients followed prospectively after intra-articular distal radius fractures. METHODS: One hundred forty-eight patients with intra-articular fractures (mean age, 47 years; age range, 44-54 years; gender distribution, 60 males and 88 females) were treated with cast only, arthroscopy/closed reduction plus pins, arthroscopy/closed reduction with external fixation, open reduction and internal fixation (ORIF) alone, and ORIF with external fixation according to surgeon preference and fracture characteristics. The 1-year outcomes across the groups were measured radiographically (n = 148) and functionally (n = 113; 1-year Wrist Outcome Measure score, Grip Strength, SF-36, and PRWE scores). RESULTS: Radiographically, the groups had statistically significant differences in radial inclination, volar tilt, intra-articular step-off, and radial shortening in the pre-treatment X-rays. However, following treatment, treatment groups demonstrated no difference statistically in their follow-up radiographic measures. One-year PRWE scores were found to be statistically different across groups. Across groups, the ORIF-alone treatment group had the highest PRWE score reflecting greatest amount of pain and disability. One-year wrist outcome measure scores and grip strength scores were also found to be significantly different across treatment groups. The general health status as measured by the SF-36 was not found to be different across treatment groups. CONCLUSIONS: These findings are consistent with treatment by indication; suboptimal ORIF outcomes may reflect older practice patterns with dorsal plating. A randomized control trial that compares treatments controlling for fracture severity and studies that develop formal clinical prediction rules for treatment assignment are needed.
Authors: W M Hopman; T Towheed; T Anastassiades; A Tenenhouse; S Poliquin; C Berger; L Joseph; J P Brown; T M Murray; J D Adachi; D A Hanley; E Papadimitropoulos Journal: CMAJ Date: 2000-08-08 Impact factor: 8.262