The Effects of Pain, Supination, and Grip Strength on Patient-Rated Disability After Operatively Treated Distal Radius Fractures

Background No consensus exists regarding postoperative splinting position following volar plate fixation of distal radius fractures. Purpose The purpose of this study was to determine whether immobilization in supination would result in superior outcomes compared with no restriction of forearm range of motion. Patients and Methods All patients >18 years of age with distal radius fractures indicated for volar plate fixation were eligible. Exclusion criteria were open fracture and concomitant injury to, or functional deficit of, either upper extremity. Patients were randomized to immobilization in (1) maximal supination with a sugar-tong splint or (2) no restriction of supination with a volar splint. Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and visual analog scale (VAS) score; wrist range of motion; and grip strength were recorded at 2 and 6 weeks postoperatively. A Student's t-test was used to compare mean values of all outcome measures at each time point. Results A total of 46 patients enrolled in the study; 28 were immobilized with a volar splint and 18 were immobilized with a sugar-tong splint. Six-week follow-up data were obtained for 32 patients. There was no significant difference in PRWE, DASH, and VAS scores; or range of motion; or grip strength between the two groups postoperatively. Conclusion Range of motion, grip strength, and patient-rated outcome measures were similar regardless of postoperative immobilization technique in patients with a distal radius fractures stabilized with a volar plate. Surgeons can elect to use the standard-of-care postoperative immobilization modality of their preference following volar plate fixation without compromising short-term return to function. Level of Evidence This is a Level II, therapeutic study.

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OUTCOME OF UNSTABLE DISTAL RADIUS FRACTURES TREATED WITH OPEN REDUCTION AND INTERNAL FIXATION VERSUS EXTERNAL FIXATION

Hand Surgery ◽

10.1142/s0218810412500165 ◽

2012 ◽

Vol 17 (02) ◽

pp. 173-179 ◽

Cited By ~ 4

Author(s):

Emmanuel P. Estrella ◽

Paulo L. Panti

Keyword(s):

Grip Strength ◽

Distal Radius ◽

Clinical Results ◽

Distal Radius Fractures ◽

Wrist Flexion ◽

Radius Fractures ◽

Wrist Extension ◽

Ulnar Deviation ◽

Mayo Wrist Score ◽

Score Range

The objective of this study was to compare the clinical results of unstable distal radius fractures treated with ORIF with plate and screws compared to EF. Patients with unstable distal radius fractures treated with ORIF or EF from January 2005 to December 2010 were reviewed in terms of the Modified Mayo Wrist Score, range of motion, pain, grip strength, and radiologic parameters. Results showed that there was no difference in the Modified Mayo Wrist Score between ORIF (17 patients) and EF (11 patients) (p = 0.07). The ORIF group had better wrist flexion, wrist extension, pronation and supination compared to the EF group (p < 0.05). There were no significant differences in terms of radial and ulnar deviation, grip strength, pain and postoperative radiologic parameters (p < 0.05). Better wrist flexion, wrist extension and forearm rotation can be expected in ORIF compared to EF in the management of unstable distal radius fractures.

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Bridging versus Nonbridging Dynamic External Fixation of Unstable Distal Radius Fractures in the Elderly with Polytrauma: A Randomized Study

Journal of Wrist Surgery ◽

10.1055/s-0039-1692480 ◽

2019 ◽

Vol 08 (05) ◽

pp. 408-415

Author(s):

Marcio Aurelio Aita ◽

Fabio Lucas Rodrigues ◽

Karyse Helena Crispim Ribeiro Alves ◽

Ricardo Kaempf de Oliveira ◽

Gustavo Mantovani Ruggiero ◽

...

Keyword(s):

Elderly Patients ◽

Grip Strength ◽

External Fixation ◽

Distal Radius ◽

Randomized Study ◽

Distal Radius Fractures ◽

Complication Rates ◽

Radius Fractures ◽

Dynamic Fixation ◽

The Mean

Background Despite the high prevalence of unstable distal radius fractures (DRFs), there is no consensus regarding the optimal method and treatment timing, especially for elderly patients with multiple associated injuries. Purpose This study aimed to compare the grip strength achieved with two different methods for definitive dynamic external fixation of DRFs in elderly patients with polytrauma operated on within the first 24 hours. Methods In this prospective randomized trial, 35 patients were assigned to undergo definitive external dynamic fixation of DRFs using the nonbridging (group A) or bridging (group B) method. The grip strength, range of motion (ROM), Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) score for pain, and radiographic characteristics were evaluated at 6 and 12 months. Results At 12 months, no significant between-group difference was observed with respect to grip strength. All patients showed results in the third or fourth quartiles. The mean ROMs were 96.94 and 96.38% and the mean QuickDASH scores were 3.53 and 3.85 in groups A and B, respectively. The VAS scores were 1.60 and 1.85 in groups A and B, respectively. The overall complication rates were 13.3 and 15% in groups A and B, respectively. Initial fracture reduction was maintained in 86.67 and 95% of the patients in groups A and B, respectively. Conclusions Both bridging and nonbridging external definitive dynamic fixation proved safe and reliable for the treatment of unstable DRFs in elderly patients with polytrauma. The grip strength results in both groups predicted the restoration of ability in elderly patients to perform activities of daily living independently.

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Dual Plating Technique for Volar Rim Fracture of the Distal Radius Using DePuy-Synthes 2.0 m and 2.4 mm Locking Plates

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s0218810417500447 ◽

2017 ◽

Vol 22 (04) ◽

pp. 423-428 ◽

Cited By ~ 1

Author(s):

Yoshihiro Abe ◽

Masahiro Suzuki ◽

Hiromasa Wakita

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Distal Radius ◽

Distal Radius Fractures ◽

Ulnar Variance ◽

Locking Plates ◽

Radius Fractures ◽

Radial Inclination ◽

The Mean

Background: To assess the surgical results of distal radius fractures with the involvement of a volar rim fragment using the DePuy-Synthes 2.0 mm and 2.4 mm locking plates.Methods: Subjects were six women and one man of average age 57 years (range, 31–83 y) and a mean follow-up period of 9 months (range, 5–19 mo) with AO B3 (volar shearing) distal radius fractures. Time of the procedure, physical examination of wrist range of motion, grip strength compared with the contralateral healthy wrist, and radiographic evaluation (volar tilt, radial inclination, and ulnar variance) were evaluated. The Visual Analog Scale (VAS: 0 points represents no pain, 100 points represents the worst pain possible) and the Quick Disability of the Arm, Shoulder, and Hand questionnaire (QuickDASH, 0 = no disability, 100 = extreme disability) were completed by patients at the final follow-up.Results: The average time of the procedure was 74 min. There were no perioperative complications. Average radiographic measures were: volar tilt, 8°; radial inclination, 23°, and ulnar variance, 0 mm. Wrist range of motion averaged 63° in wrist extension (range, 55–80°) and 55° in wrist flexion (range, 45–65°). Grip strength averaged 81% of the contralateral side at final evaluation (range, 67–100%). The mean QuickDASH score was 3.0 points (range, 0–9.1 points) and the mean VAS for pain was 9.3 at final follow-up.Conclusions: Open reduction internal fixation with the DePuy-Synthes 2.0 mm and 2.4 mm locking plates is an effective means of fixing a distal radius fracture that includes a volar rim fragment without interfering with flexor tendon gliding.

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The relationship between radiological alignment of united distal radius fractures and functional and patient-perceived outcomes in elderly patients

Journal of Orthopaedic Surgery ◽

10.1177/2309499016684976 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668497 ◽

Cited By ~ 2

Author(s):

Erik Hohmann ◽

Mahendrakumar Meta ◽

Vasudev Navalgund ◽

Kevin Tetsworth

Keyword(s):

Elderly Patients ◽

Grip Strength ◽

Distal Radius ◽

Distal Radius Fractures ◽

Ulnar Variance ◽

Pinch Strength ◽

Radius Fractures ◽

Radial Inclination ◽

Perceived Outcomes ◽

The Relationship

Purpose: The purpose of this study was to investigate the relationship between radiological alignment and functional outcomes including strength, range of motion (ROM), and disabilities of the arm, shoulder, and hand (DASH) and patient-rated wrist evaluation (PRWE) scores in elderly patients with united distal radius fractures. Methods: We reviewed 118 patients (mean age of 76.2 ± 9.5 years, mean follow-up 36.3 ± 17.6 months). Outcome measures included the DASH and PRWE scores, ROM, and grip and pinch strength were measured using a validated mobile hand-held dynamometer. Radial height, radial inclination, ulnar variance, and palmar tilt were measured on standard radiographs. Results: The mean total score for DASH was 4.9 ± 7.4 and 6.9 ± 11 for the PRWE. There were significant differences in ROM for palmar flexion and ulnar deviation between the affected wrist and the normal wrist. Linear regression revealed significant relationships for the following variables: between DASH and radiological palmar tilt, between PRWE and radiological palmar tilt, between grip strength and radial inclination, between grip strength and radial height, and between grip strength and ulnar variance. Conclusion: This study suggests that minor deformities of the distal radius following distal radius fractures treated with either operative or nonoperative treatment are unlikely to be clinically relevant and have no impact on patient perceived outcomes for elderly patients.

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Percutaneous Threaded Pin Fixation of Distal Radius Fracture in the Athlete

Hand ◽

10.1177/1558944720975135 ◽

2020 ◽

pp. 155894472097513

Author(s):

Patrick M. Luchini ◽

Julie E. Glener ◽

Justin Vaida ◽

Lucy A. McCabe ◽

Andrea B. Lese ◽

...

Keyword(s):

Grip Strength ◽

Distal Radius ◽

Postoperative Period ◽

Complete Healing ◽

Early Rehabilitation ◽

Distal Radius Fractures ◽

Return To Play ◽

Radiographic Evaluation ◽

Radius Fractures ◽

Pin Fixation

Background The purpose of this study was to examine the outcomes and return to play with early rehabilitation in athletes who sustained unstable extra-articular distal radius fractures treated with a purpose-designed threaded pin technique. Methods This prospective study examined athletes with displaced and unstable distal radius fractures treated surgically with purpose-designed threaded pins. Patients were enrolled in an early rehabilitation protocol, with formal therapy initiated on postoperative days 1 to 3. Range of motion and strength measurements were documented throughout the postoperative period, noting the time until return to athletic competition. These results were compared with historical values using other forms of fixation Results Nineteen athletes, average age of 35 years, were treated with threaded pin technique with early rehabilitation; all had complete healing and maintained alignment based on radiographic evaluation. The average time span between surgery and release to competition was 8 weeks, with all but 1 patient returning to sport within 12 weeks of injury. Average postoperative flexion measured 58°, extension was 57°, pronation was 81°, and supination was 74°. JAMAR grip strength in position 3 measured 25.22 kg, which equated to 73% of the uninjured side’s grip strength at the time of release to play. Conclusions Surgical fixation using a purpose-designed threaded pin is a useful alternative to volar plating for isolated radial styloid and extra-articular distal radius fractures in athletes. The purpose-designed threaded pin may afford athletes rapid recovery during the early postoperative period, preserving strength and dexterity and minimizing time lost before return to play.

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A Randomized Trial Assessing the Muscle Strength and Range of Motion in Elderly Patients Following Distal Radius Fractures Treated With 4- and 6-Week Cast Immobilization

Journal of Clinical Medicine ◽

10.3390/jcm10245774 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5774

Author(s):

Jarosław Olech ◽

Grzegorz Konieczny ◽

Łukasz Tomczyk ◽

Piotr Morasiewicz

Keyword(s):

Muscle Strength ◽

Elderly Patients ◽

Range Of Motion ◽

Grip Strength ◽

Distal Radius Fracture ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Cast Immobilization ◽

The Mean

Background: There is no consensus among orthopedic surgeons as to the required period of cast immobilization in distal radius fractures in elderly patients. The purpose of this study was to assess muscle strength and range of motion symmetry in elderly patients after distal radius fractures with different periods of cast immobilization. Methods: This study evaluated 50 patients (33 women and 17 men), aged over 65 years, after cast immobilization treatment for distal radius fracture. The mean age at the beginning of treatment was 71 years. The mean duration of follow-up was 1 year and 3 months. The first subgroup (n = 24) comprised the patients whose fractures had been immobilized in a cast for 6 weeks, another subgroup (n = 26) comprised the patients with 4-week cast immobilization. We assessed: 1) muscle strength, 2) range of motion. Results: The mean grip strength in the treated limb was 71% and 81% of that in the healthy limb in the groups with 4-week and 6-week cast immobilization, respectively (p = 0.0432). The study groups showed no differences in the mean grip strength in the treated limbs or the mean grip strength in the healthy limbs. The mean treated limb flexion was 62° and 75° in the 4-week and 6-week immobilization groups, respectively (p = 0.025). The evaluated groups showed no differences in terms of any other range of motion parameters. The grip strength and range of motion values were significantly lower in the treated limb than in the healthy limb in both evaluated groups. Only the values of wrist radial deviation in the 6-week cast immobilization group showed no differences between the treated and healthy limbs. Conclusion: Higher values of injured limb muscle strength and greater mean range of wrist flexion were achieved in the 6-week subgroup. Neither of the evaluated groups achieved a symmetry of muscle strength or range of motion after treatment. Full limb function did not return in any of the elderly distal radius fracture patients irrespective of cast immobilization duration.

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TREATMENT WITH OR WITHOUT INTERNAL FIXATION FOR ULNAR STYLOID BASE FRACTURES ACCOMPANIED BY DISTAL RADIUS FRACTURES FIXED WITH VOLAR LOCKING PLATE

Hand Surgery ◽

10.1142/s0218810412500177 ◽

2012 ◽

Vol 17 (02) ◽

pp. 181-190 ◽

Cited By ~ 9

Author(s):

Yukichi Zenke ◽

Akinori Sakai ◽

Toshihisa Oshige ◽

Shiro Moritani ◽

Toshitaka Nakamura

Keyword(s):

Internal Fixation ◽

Grip Strength ◽

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Dash Score ◽

Radius Fractures ◽

Ulnar Styloid ◽

Fixation Group ◽

Significant Difference

The purpose of this study was to evaluate the treatment results, with and without internal fixation of ulnar styloid base fractures associated with acute distal radius fractures. A total of 48 patients were enrolled, including 20 patients treated by internal fixation (fixation group) and 28 treated without internal fixation (non-fixation group). The evaluated parameters were postoperative range of motion, grip strength, DASH score, and the presence or absence of ulnar wrist pain over time. The outcome was assessed as "excellent" in 15 patients of the fixation group and 21 patients of the non-fixation group, and "good" in five patients of the fixation group and seven patients of the non-fixation group. There were no significant differences in the clinical outcomes or any of the parameters at the final evaluation between the two groups. However, the grip strength was significantly better in the non-fixation group than in the fixation group until 12 weeks postoperatively. The overall clinical outcome was good in both groups, with no significant difference between the groups.

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Intramedullary Fixation of Distal Radius Fractures Using CAGE-DR Implant

Journal of Wrist Surgery ◽

10.1055/s-0038-1669438 ◽

2018 ◽

Vol 07 (05) ◽

pp. 358-365

Author(s):

Schneider Rancy ◽

Stephanie Malliaris ◽

Eric Bogner ◽

Scott Wolfe

Keyword(s):

Internal Fixation ◽

Grip Strength ◽

Distal Radius ◽

Fracture Fixation ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Level Of Evidence ◽

Promising Alternative ◽

Pain Scores

Purpose CAGE-DR implant is a novel Food and Drug Administration approved intramedullary fracture fixation device used for distal radius fractures. We examine a series of 22 patients and report the outcomes with this device. Materials and Methods A total of 24 patients with distal radius fractures (8 articular AO type C1/C2; 16 extra-articular AO type A2/A3) underwent open reduction and internal fixation (ORIF) using CAGE-DR implant by a single surgeon. Data including fracture type, angle of displacement, radiographic consolidation, grip strength, wrist range of motion (ROM), patient-rated wrist evaluation (PRWE), and Visual Analog Scale (VAS) pain scores were recorded at time of surgery and at standard follow-up. Results All 24 patients underwent uneventful ORIF. At first follow-up visit (9 days), all patients had full digital ROM (measured as 0 cm tip-to-palm distance). Two patients were lost to follow-up. Eighteen of the remaining 22 patients had sufficient radiographic follow-up and all 18 demonstrated healing. At latest follow-up (mean 9.7 months, range, 3–20), VAS pain scores averaged 0.6 (range, 0–8) and PRWE averaged 12.1 (range, 0–53.5). Grip strength of the operated hand averaged 58 lbs (range, 20–130). ROM included: wrist flexion 73° (50–95), wrist extension 78° (60–110), pronation 77° (60–90), supination 79° (60–90), ulnar deviation 31° (5–45), and radial deviation 17° (10–30). Three patients underwent screw removal to prevent tendon irritation. One patient underwent hardware removal due to prominence on imaging but was asymptomatic. There were otherwise no major complications, including complex regional pain syndrome, in the series to date. Conclusion The CAGE-DR fracture fixation system is a promising alternative to established methods of distal radius internal fixation. This series has a low reported pain score starting immediately postoperatively and a low complication rate. This novel device is a promising option for internal fixation of displaced distal radius fractures with a low complication profile. Level of Evidence This is a level IV, therapeutic study.

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173 Early Results of a Variable-Angle Volar Locking Plate for Distal Radius Fractures: A Bi-Centre Study

British Journal of Surgery ◽

10.1093/bjs/znab134.122 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Elerian ◽

T Singh ◽

N A Jagodzinski ◽

R Norris ◽

S Tan ◽

...

Keyword(s):

Grip Strength ◽

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Dash Score ◽

Radius Fractures ◽

Centre Study ◽

Articular Fractures ◽

Variable Angle ◽

Flexion Extension

Abstract Introduction This study examines the clinical, functional and radiological outcomes of distal radius fracture fixation with the Aptus® (Medartis, Pennsylvania) locking plate in order to determine its efficacy and to identify notable findings related to treatment variations. Method This is a retrospective bi-centre study collecting patient details from a District General Hospital and a Regional Hand Unit. We assessed 61 consecutive patients with distal radius fractures (AO grade A = 19, B = 9, C = 33) fixed using Aptus® plate with a minimum of six months follow-up. Outcome measures included the DASH score, wrist range of movement and grip strength, and complications. Radiographs were reviewed to assess restoration of anatomy and union. Results All but two fractures united within six weeks. Mean ranges of movement were only mildly restricted compared to the normal wrist (flexion/extension = 102°; radial/ulna deviation = 53°; pronation/supination = 169°). Mean postoperative grip strength was 23.8kg which was comparable to the contralateral side at 31.5kg. The mean DASH score was 18.2. Seven patients had screws misplaced outside the distal radius although three of these remained asymptomatic. Conclusions Variable-angle locking systems benefit from flexibility of implant positioning and may allow enhanced inter-fragmentary reduction for accurate fixation of intra-articular fractures.

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