A Relationship between Dart-Throwing Motion Plane ROM and the DASH Score after Distal Radius Fracture

Introduction. Internal fixation with volar locking plate (VLP) was widely adopted as a first-line choice in treatment of distal radius fracture (DRF). Methods. Total 315 patients with distal radius fracture receiving VLP fixation were included for analysis in this study. The rehabilitation protocol was started immediately after surgery for all patients. During the initial two weeks after surgery, 149 patients received 200 mg celecoxib twice per day, 89 received buprenorphine transdermal patch at 5 μg/h, and 77 received 13 mg codeine plus 200 mg ibuprofen twice per day for pain management. Visual analog scale (VAS) scores of pain at rest, daily activity, and rehabilitative exercise were measured, respectively, every week according to the experiences of the past week in the initial six weeks after surgery. Functional outcomes including range of motion (ROM) for extension, flexion, pronation, supination, ulnar and radial abduction, the disabilities of arm, shoulder, and hand (DASH) score and the validated patient rated wrist evaluation (PRWE), and grip strength were collected at one, three, and six months after surgery. Results. We showed that patients receiving transdermal buprenorphine and codeine/ibuprofen had decreased VAS scores during rehabilitative exercise, better compliance to the rehabilitation program, and thus faster functional recovery. Conclusions. We recommend transdermal buprenorphine or codeine/ibuprofen for pain management during rehabilitation after distal radius fracture stabilized with VLP.

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Clinical outcomes in management of unstable distal radius fractures treated with external fixation and internal fixation: a prospective comparative study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173932 ◽

2017 ◽

Vol 3 (5) ◽

pp. 1004 ◽

Cited By ~ 1

Author(s):

Sunil Kumar Dash ◽

Manish Kumar Sharma ◽

Sanket Mishra ◽

Hatia Marandi ◽

Aurobinda Das ◽

...

Keyword(s):

Internal Fixation ◽

Distal Radius Fracture ◽

Distal Radius ◽

Functional Recovery ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Dash Score ◽

Radius Fractures ◽

Articular Fractures ◽

Group I

Background: Management of Distal Radius fracture that are inherently unstable is still a matter of debate. There is no conclusive evidence that support one surgical fixation method over another. An attempt was made to analyze patients treated with Ex-Fix and Internal-Fixation for unstable distal radius fractures and evaluate the clinical efficacy of Ex-fix using principles of ligamentotaxis and Internal-fixation and compare functional recovery, fracture healing time and complications.Methods: A prospective trial was undertaken at our hospital with 35 patients,all aged >20 yrs with closed distal radius fracture and divided into two groups: group I (Ex-fix with or without percutaneous k-wire, and JESS) and group II (Int-Fixation) including 14 and 21 patients, respectively. Periodic clinical examination and x-ray review was carried out to find out fracture union, and functional assessment. Patients were followed up for 1 year, 6 months average.Results: Group I consumed significant less operative time, fluoroscopic exposure, reduced hospital stay, quicker post-operative pain relief. Quick DASH score were significantly high in elderly treated with Ex-Fix in comparison to young in which DASH score was higher with internal-fixator. Functional recovery was early with int-fixation but post-operative wrist stiffness was also higher. 2 cases of delayed wound healing &1 case of pin tract infection with ex-fix application was observed. Conclusions: Internal-fixation remains the treatment of choice for unstable distal radius fracture involving the articular surface and in the young, while ext-fixation can be considered as a primary treatment modality in the extra-articular fractures in young or even intra-articular fractures in the elderly.

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Comparing Outcomes between Arthroscopic-Assisted Reduction and Fluoroscopic Reduction in AO Type C Distal Radius Fracture Treatment

Journal of Wrist Surgery ◽

10.1055/s-0040-1719039 ◽

2020 ◽

Author(s):

Siu Cheong Jeffrey Justin Koo ◽

Kam Yiu Adrian Leung ◽

Wai Wang Chau ◽

Pak Cheong Ho

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Grip Strength ◽

Distal Radius Fracture ◽

Distal Radius ◽

Fracture Reduction ◽

Radius Fracture ◽

Dash Score ◽

Type C ◽

Assisted Fracture

Abstract Background Distal radius fracture is one of the most common injuries. Poor functional result with restricted wrist motion can be developed when there is intra-articular fibrous tissue development arising from articular step-off and gapping. Objectives The aim of this study is to compare the functional and radiological outcome between arthroscopic-assisted reduction and fluoroscopic reduction in treating unstable intra-articular distal radius fracture. Methods We retrospectively analyzed 12 patients with intraarticular AO type C distal radius fracture treated with arthroscopic-assisted fracture reduction and internal fixation and compared them with another group of 12 patients in which fracture reduction is assessed by fluoroscopy alone (15 males and 9 females, mean age 57.3, range 27–73). The two cohorts were analyzed for differences in radiological parameters including articular stepping and gapping, palmar tilt, radial inclination, ulnar variance as well as functional outcome in range of motion, grip strength, modified mayo wrist score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score at an average of 12.5 months (range 5–26) after surgery. Results Arthroscopic-assisted fracture reduction group has statistically better restoration of articular stepping and gapping, volar tilt and ulnar variance. Range of motion, grip strength, modified mayo wrist score and Quick DASH score also had statistically significant improvement in arthroscopic group. Conclusion Our study showed arthroscopic-assisted technique can precisely restore radiological parameters in highly comminuted distal radius fracture with good functional outcome. Also, associated intra-articular soft tissue injury can be detected and treated simultaneously. Level of Evidence This is a level III, retrospective cohort study.

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Home exercise in the dart-throwing motion plane after distal radius fractures: A pilot randomized controlled trial

Journal of Hand Therapy ◽

10.1016/j.jht.2020.03.027 ◽

2020 ◽

Author(s):

Yael Kaufman-Cohen ◽

Yafi Levanon ◽

Jason Friedman ◽

Yona Yaniv ◽

Sigal Portnoy

Keyword(s):

Randomized Controlled Trial ◽

Distal Radius ◽

Controlled Trial ◽

Home Exercise ◽

Radius Fractures ◽

Randomized Controlled ◽

Dart Throwing ◽

Throwing Motion ◽

Pilot Randomized Controlled Trial ◽

Motion Plane

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Disability and Pain are the Best Predictors of Sick Leave After a Distal Radius Fracture in Men

Journal of Occupational Rehabilitation ◽

10.1007/s10926-020-09880-4 ◽

2020 ◽

Vol 30 (4) ◽

pp. 656-664 ◽

Cited By ~ 2

Author(s):

Lisa Egund ◽

Karin Önnby ◽

Fiona Mcguigan ◽

Kristina Åkesson

Keyword(s):

Sick Leave ◽

Distal Radius Fracture ◽

Distal Radius ◽

Treatment Method ◽

Radius Fracture ◽

Dash Score ◽

Related Factors ◽

Health Lifestyle ◽

The Difference ◽

The Impact

AbstractPurpose Distal radius fracture often compromises working ability, but clinical implications are less studied in men due to its lower incidence. This study therefore describes sick leave in men with distal radius fracture, specifically exploring the impact of patient- and fracture-related factors. Methods Professionally active men aged 20–65 with distal radius fracture were followed prospectively for 1-year (n = 88). Data included treatment method, radiographic parameters pre/post treatment, complications, health, lifestyle and occupational demand. Patient outcomes were self-reported sick leave; Disability of the Arm, Shoulder and Hand (DASH) score; pain (5 likert scale); SF-36: Physical Component Scale (PCS) and Mental Component Scale (MCS). Results Median sick leave was 4 weeks (IQR 0; 8); almost a third reported taking no sick leave. Categorizing sick leave into 3 groups (0–6, 7–12 and > 12 weeks), men with the longest sick leave had 22 points higher DASH score (p = 0.001) and 5 points lower PCS (p = 0.02) at 1 week and the difference remained over time; they were also older and more often treated surgically. The strongest predictors of length of sick leave were one-week post-fracture DASH score (rs = 0.4, p < 0.001), pain intensity (rs = 0.4, p < 0.001) and PCS (rs = − 0.4, p = 0.002). The correlation between sick leave and pain was even stronger analyzing treatment groups separately (closed reduction and cast rs = 0.56, p = 0.007, surgery rs = 0.42, p = 0.04). Conclusions Self-reported disability, pain and global health measurements as early as 1 week post-fracture are the strongest predictors of length of sick leave regardless of treatment; an important finding easily transferrable to clinical management of distal radius fractures.

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Kinematic Analyses Using Finger-Tapping Task for Patients After Surgery With Distal Radius Fracture at Acute Phase

Hand ◽

10.1177/1558944720949952 ◽

2020 ◽

pp. 155894472094995

Author(s):

Ryota Imai ◽

Michihiro Osumi ◽

Tomoya Ishigaki ◽

Shu Morioka

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Finger Tapping ◽

Radius Fracture ◽

Dash Score ◽

Slight Improvement ◽

Movement Initiation ◽

Velocity Magnitude ◽

Kinematic Characteristics ◽

Kinematic Analyses

Background After a distal radius fracture (DRF), severe pain, disabilities, and pain-related psychological problems can arise and sometimes remain ~1 year later. DRF-related disabilities have been assessed with questionnaires but not by kinematic evaluations; the kinematic features of DRF patients are unknown. Here, we investigated the kinematic characteristics of DRF patients and explored the relationship between their clinical assessments and kinematic characteristics. Methods: We analyzed 20 patients with DRFs after their surgeries. We recorded their finger-tapping using a magnetic sensor, and we calculated the velocity, magnitude, and movement-initiation hesitation. The patients’ pain intensity and fear of movement were assessed by a visual analogue scale and the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH). To investigate the features of the patients who achieved only slight improvement, we compared the kinematic characteristics of the DRF patients in 2 subgroups: the “good improvement group” and the “slight improvement group” based on a cutoff value of the DASH score (>40) at 1 month postsurgery. Results: The DASH score at 30 days postsurgery was significantly correlated with hesitation at 1 day postsurgery ( r = .66, P < .0071) and with velocity at 7 days ( r = −.54, P < .0071). Our kinematic analyses revealed significant differences in velocity at 7 days postsurgery ( P < .05) and in hesitation at 1 day postsurgery ( P < .05) between the subgroups. Conclusions: Since assessments using range-of-motion measurements or a questionnaire are not sufficient to evaluate a patient’s movement disorder, a kinematic analysis should be conducted for quantitative assessments.

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Did Covid-19 pandemic narrow the spectrum of surgical indications?

10.25083/2559.5555/6.1.11 ◽

2021 ◽

Vol 6 (1) ◽

pp. 58-63

Author(s):

Ahmet Keskin ◽

Bulent Karslioglu

Keyword(s):

Conservative Treatment ◽

Distal Radius Fracture ◽

Distal Radius ◽

Ankle Fracture ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Treatment Algorithm ◽

Humerus Fracture ◽

Radius Fracture ◽

Dash Score

Introduction. The Covid-19 outbreak has changed orthopedic practices more than expected. We are going through a period in which conservative treatment will become prominent when deciding on fractures with indistinct surgical margins in guidelines. Considering global tendency for surgical interventions in the pre-pandemic period, we tried to find out the answer to the following question: will conservative treatment be the shining star in the post pandemic period? Materials and Methods. 262 patients who were with “gray zone fractures-injuries” like extraarticular distal radius fracture, proximal humerus fracture and Weber type B ankle fracture was treated conservatively during March and August, 2020. Open or pathological fracture, fractures with vascular or neurological injury and fractures involving the articular joint were excluded. Results. 59 patients with proximal humerus fracture followed with arm-sling. Mean ASES scores at 6th was 48.3 and 69.9 12th week. 91 patients with Weber B-type ankle fracture were followed up with below-knee plaster for 6 weeks. American Orthopedic Foot & Ankle Score was 48 in the 6th week and 75 in the 12th week. 90 patients with distal radius fracture were followed up with plaster. Malunion was detected at 5 patients. Mean Quick Dash score at 6th weeks was 52.3 and 29.5 at 12th weeks. Mean wrist flexion was 450, wrist extension was 350, forearm supination 600 and forearm pronation was 700 at final control. Conclusions. The conservative treatment experiences we have gained from pandemic periods probably will change our treatment algorithm.

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The Usefulness of Radial Column Plate in Distal Radius Fracture: Indications and Results

Archives of Hand and Microsurgery ◽

10.12790/ahm.21.0091 ◽

2021 ◽

Author(s):

Sung Jin An ◽

Sang Hyun Lee ◽

Dong Hee Kim ◽

Hyo Seok Jang ◽

Sung Min Hong ◽

...

Keyword(s):

Surgical Treatment ◽

Distal Radius Fracture ◽

Distal Radius ◽

Articular Surface ◽

Radius Fracture ◽

Dash Score ◽

Locking Plates ◽

Radial Inclination ◽

Significant Difference ◽

Radial Length

Purpose: The most common surgical treatment for distal radius fracture is internal fixation using volar locking plates, but it is sometimes difficult to maintain reduction with them. Therefore, this research reports the results of surgical treatment with additional radial column plates.Methods: We analyzed 12-month follow-up results in 100 cases. The patients had the B or C types of distal radius fractures, in accordance with AO classification, and underwent surgical treatment at our hospital from May 2013 to December 2019. There were 16 cases of B-type and 84 cases of C-type fractures. Out of these, 87 were treated with volar locking plates (V group) and 13 had additional radial column plates (VR group). The results of surgical treatment were examined clinically by measuring the disabilities of the arm, shoulder and hand (DASH) and Mayo wrist score, and radiologically by measuring the radial length, radial inclination, and volar tilt, before and after surgery.Results: After treatment, the radiographic average in the V group showed a radial length of 12.3 mm, radial inclination of 20.2°, and volar tilt of 5.8°, while the VR group showed 11.6 mm, 22.3°, and 9.0° respectively. A statistically significant difference was found in the DASH score, and the DASH score showed good results in the VR group.Conclusion: Additional radial column plate fixation is worth considering because it provides clinically and radiologically satisfactory results in treatment of B and C types distal radius fracture involving articular surface.

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