Jonathan Cowie1, Raymond Anakwe2, Margaret McQueen3. 1. Victoria Hospital Kirkcaldy, Kirkcaldy, United Kingdom. 2. St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom. 3. Edinburgh Orthopaedic Trauma Unit, Edinburgh, United Kingdom.
Abstract
PURPOSE: To identify factors that affect functional outcome one year after distal radial fracture treatment. METHODS: 521 women and 121 men aged 16 to 92 (mean, 59) years with distal radial fractures underwent external fixation (n=123), open reduction and internal fixation (n=63), a combination of both (n=10), distal radial osteotomy for symptomatic malunion (n=90), or casting with (n=194) or without (n=162) prior closed manipulation under regional anaesthesia. The indication for surgery (rather than casting) was metaphyseal instability. Radiographic evaluation (dorsal angulation, radial shortening, carpal malalignment, and malunion) was made before and after treatment and after fracture healing. Functional evaluation (range of movement, grip strength, and activities of daily living) was made at a mean of 16 (range, 6-54) months after injury. RESULTS: After multiple regression analysis, poorer functional score was associated with increasing age (p<0.001), dorsal angulation after healing (p<0.016), presence of volar comminution (p=0.005), and pain (p<0.001). Poorer grip strength was associated with non-dominant side injury, increasing age, dorsal angulation after healing, positive ulnar variance, comminution, and pain (all p<0.001). Predicted malunion showed colinearity with age (r=0.657), dorsal comminution (r=0.694), and dorsal angulation (r=0.626). CONCLUSION: Understanding factors associated with outcome helps surgeons to make the treatment decision for distal radial fracture to achieve optimum outcome.
PURPOSE: To identify factors that affect functional outcome one year after distal radial fracture treatment. METHODS: 521 women and 121 men aged 16 to 92 (mean, 59) years with distal radial fractures underwent external fixation (n=123), open reduction and internal fixation (n=63), a combination of both (n=10), distal radial osteotomy for symptomatic malunion (n=90), or casting with (n=194) or without (n=162) prior closed manipulation under regional anaesthesia. The indication for surgery (rather than casting) was metaphyseal instability. Radiographic evaluation (dorsal angulation, radial shortening, carpal malalignment, and malunion) was made before and after treatment and after fracture healing. Functional evaluation (range of movement, grip strength, and activities of daily living) was made at a mean of 16 (range, 6-54) months after injury. RESULTS: After multiple regression analysis, poorer functional score was associated with increasing age (p<0.001), dorsal angulation after healing (p<0.016), presence of volar comminution (p=0.005), and pain (p<0.001). Poorer grip strength was associated with non-dominant side injury, increasing age, dorsal angulation after healing, positive ulnar variance, comminution, and pain (all p<0.001). Predicted malunion showed colinearity with age (r=0.657), dorsal comminution (r=0.694), and dorsal angulation (r=0.626). CONCLUSION: Understanding factors associated with outcome helps surgeons to make the treatment decision for distal radial fracture to achieve optimum outcome.
Authors: Viktor Schmidt; Cecilia Mellstrand Navarro; Marcus Ottosson; Magnus Tägil; Albert Christersson; Markus Engquist; Arkan Sayed-Noor; Sebastian Mukka; Mats Wadsten Journal: PLoS One Date: 2022-02-10 Impact factor: 3.240
Authors: Penny R Atkins; Kerstin Stock; Nicholas Ohs; Caitlyn J Collins; Lukas Horling; Stefan Benedikt; Gerald Degenhart; Kurt Lippuner; Michael Blauth; Patrik Christen; Ralph Müller Journal: JBMR Plus Date: 2021-04-08