Prevalence of posttraumatic arthritis following distal radius fractures in non-osteoporotic patients and the association with radiological measurements, clinician and patient-reported outcomes

Abstract

IntroductionOutcomes of non-osteoporotic patients who sustained a distal radius fracture (DRF) have not gained much attention in recent literature. The aims of this study were to determine the prevalence of posttraumatic arthritis (PA), to analyze associations of radiological measurements, clinician-reported and patient-reported outcomes (CROs and PROs) with PA and gain insight into employment changes after DRF in non-osteoporotic patients.MethodsNon-osteoporotic patients following a DRF were selected. Radiographs of both wrists were obtained at follow-up and the degree of PA was determined. Radiological measurements consisted of grading of PA, ulnar variance, radial length, radial inclination, dorsal tilt, distal radio-ulnar joint width, scapholunate dissociation, step-off and gap. Active range of motion and grip strength measurements were performed and all patients filled in four questionnaires to assess pain, upper extremity functioning, and health status (Disability of Arm, Shoulder and Hand; Patient Reported Wrist Evaluation; Michigan Hand Questionnaire; Short Form-36).ResultsSeventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years were included. Prevalence of PA was 32% at a median follow-up of 62.0 months. Patients with PA had statistically significant longer radial length (1.1 mm, 95% CI − 2.1; − 0.0, p = 0.045). Patients with PA had a statistically significant diminished flexion/extension arc of motion (12.0°, p = 0.008) and ulnar/radial deviation arc of motion (6.3°, p = 0.018). When corrected for dominance, all grip strength measurements were not statistically significantly different between patients with and without PA. Statistically significant poorer PROs in patients with PA were the MHQ subscales general functioning (65 versus 75, p = 0.018), esthetics (94 versus 100, p = 0.037), satisfaction (75 versus 92, p = 0.042) and total score of the MHQ (83 versus 91, p = 0.044), as well as the SF-36 subscale physical functioning (95 versus 100, p = 0.028). In regression analyses the DASH, PRWE function and PRWE total were statistically significantly associated with flexion/extension arc of motion. Seven patients (10%) changed or left their occupation because of the DRF.ConclusionNon-osteoporotic patients had a considerably high prevalence of PA following DRFs, despite a relatively short follow-up time. Patients with longer radial length more often had PA. Irrespective of AO/OTA fracture type, patients with PA had diminished range of motion, but no altered grip strength measurements. Non-osteoporotic patients following DRFs perceived diminished general functioning and dissatisfaction, which was impacted by the diminished active range of motion. Pain or impaired general health status was not reported. The PRO MHQ might be a valuable evaluation tool in this patient group. Change of occupation following DRFs should receive attention in further research.

Biomechanical considerations on a CT-based treatment-oriented classification in radius fractures

“…The treatment options for DRFs have vastly improved over the years. Beginning with conservative treatment including closed reduction and plaster casts [1][2][3][4][5][6][7][8], K-wires were the first invasive method of stabilization. They were partly used in combination with external fixation.…”

Graded response model fit, measurement invariance and (comparative) precision of the Dutch-Flemish PROMIS® Upper Extremity V2.0 item bank in patients with upper extremity disorders

“…It is known that grip strength is merely a reflection of overall muscle strength and condition of a chain of muscles in the upper limb and at longterm follow-up is not severely impacted by hand or wrist injury [52][53][54]. In contrast, range of motion is significantly impacted by hand and wrist injuries and influences fine tactile functioning [53][54][55]. Therefore, we hypothesize that arm/shoulder problems impact heavy lifting activity, but to a lesser extent fine tactile functioning.…”

“…For example, all DIF results for location of complaint indicated that among patients with the same overall level of UE functioning, patients with only hand/wrist injuries indicated more problems with activities that involve fine tactile functioning and patients with only shoulder problems indicated more problems with activities involving heavy lifting tasks, reaching above shoulder level or behind the back. It is known that grip strength is merely a reflection of overall muscle strength and condition of a chain of muscles in the upper limb and at longterm follow-up is not severely impacted by hand or wrist injury [52][53][54]. In contrast, range of motion is significantly impacted by hand and wrist injuries and influences fine tactile functioning [53][54][55].…”

Arthroscopic assisted treatment of distal radius fractures and concomitant injuries

“…A main indication for arthroscopy in DRFs is an intra-articular step or gap from 1 to 2 mm after closed reduction [5], which is a prognostic factor for post traumatic osteoarthritis [16,17]. Arthroscopically assisted treatment of DRFs can help detecting and treating scaphoid fractures and/or ligament injuries.…”