A Cohort Study of One-Year Functional and Radiographic Outcomes following Intra-Articular Distal Radius Fractures

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.

Distal Radius Fractures: Evaluation of Closed Reduction and Percutaneous Kirschner Wire Pinning

“…21 Published data indicate that less invasive treatment methods may lead to better subjective outcomes in specific fracture types. 22,23 This is in contrast with a prospective randomized trial indicating that the early postoperative functional outcomes seem to be in favor of ORIF, although none of these two treatment methods showed superiority in terms of long-term radiographic or functional outcomes. 24 A prospective randomized trial comparing the results of early rehabilitation after ORIF to delaying rehabilitation for 6 weeks showed no difference in clinical outcomes after 6 months.…”

Fracturas intraarticulares de radio distal: reducción bajo fluoroscopía versus asistencia artroscópica. Revisión sistemática

“…En relación a la fecha de publicación sólo un artículo fue publicado entre 1990 y 1999, 14 un artículo entre 2000 y 2009, 12 cinco fueron publicados entre 2010 y Mayo de 2017. 11,16,17,18,19 En cuanto al tipo de estudio, se incluyeron tres ensayos de cohorte prospectivo aleatorizado (Nivel de evidencia II+), 11,14,18 dos estudios de cohorte prospectivo no aleatorizado (Nivel de evidencia II -), 12,17 un trabajo de cohorte no aleatorizado con un grupo prospectivo y otro retrospectivo (Nivel de evidencia II-) 16 y un estudio serie de casos retrospectivo (Nivel de evidencia III). 19 Se evaluó un total de 463 pacientes pertenecientes a los siete estudios revisados, que incluyeron 256 mujeres y 207 hombres, con una edad promedio de 48.29 años, con un rango de 39 a 64 años.…”

“…Seis trabajos 11,12,14,16,18,19 utilizaron la clasificación AO/ ASIF 20 para radio distal; sin embargo, dos de ellos sólo nombran la clasificación, pero no desglosan el número de casos de cada tipo de fractura. 11,12 Sólo en el trabajo realizado por Lalone y colaboradores 17 se utilizó la clasificación McMurtry, 20 que considera el número de fragmentos articulares sin valorar el desplazamiento de éstos, clasificación actualmente de poco uso.…”

“…Los métodos utilizados para la evaluación funcional fueron heterogéneos, la escala DASH 21 (Disabilities of the Arm, Shoulder and Hand) fue la más elegida, seleccionada en cuatro trabajos, 11,12,16,18 Kordasiewicz y colaboradores 16 además emplearon la escala visual análoga para el dolor (EVA). Lalone y su equipo 17 utilizaron la escala PRWE (Patient-Rated Wrist Evaluation), Doi y colegas Clasificación Funcional de Garltland y Werley. 20 Sólo un trabajo evaluó el tiempo de reincorporación laboral.…”

Linking of the American Academy of Orthopaedic Surgeons Distal Radius Fracture Clinical Practice Guidelines to the International Classification of Functioning, Disability, and Health; International Classification of Diseases; and ICF Core Sets for Hand Conditions

“…Distal radius fracture (DRF) is one of the most common types of fracture 7,25,31 that can cause substantial pain, disability, 6,14,24,29,30,37 and health care burden. 6 Study shows that more than 640 000 cases of DRF were reported during 2001 in North America, 14 and nearly 372 000 individuals of age 65 years and older sustain DRF every year in the United States.…”