Session IV - Upper Extremity


Fri., 10/21/05 Upper Extremity, Paper #17, 9:57 am

Outcome after Operative Treatment of Distal Radius Fractures: Does Function follow Form?

Christopher Gorczynski, MD1 (n); Kenneth J. Koval, MD2 (n);
Kenneth A. Egol, MD1 (n); Rudi Hiebert, BS1 (n);
1NYU-Hospital for Joint Diseases, New York, New York, USA
2Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA

Purpose: The purpose of this IRB-approved prospective trial was to evaluate the functional significance of loss of volar tilt when using external fixation to treat unstable distal radius fractures.

Methods: 80 consecutive patients were treated with external fixation and supplemental K-wire fixation for displaced unstable distal radius fractures. 67 patients were followed for a minimum of 1 year and evaluated clinically and radiographically. All fixators were placed under a standardized protocol that included all initial postoperative dressings. Patients were followed at 6, 12, 24, and 52 weeks. Radiographs were obtained at each follow-up interval and were judged based on radial height, length, and volar tilt. In addition, objective functional outcome (DASH) and subjective outcomes (Gartland score) were obtained. Radiographic outcomes were graded and compared to the functional results for correlation using a Spearman Rank Correlation coefficient.

Results: The study group consisted of 80 patients with 82 distal radius fractures, 46 females and 34 males. There were 37 left wrists, 41 right wrists, and 2 bilaterals. Mechanism of injury included falls in 73 patients, motor vehicle collision in 4 cases, and struck by a vehicle in 3 cases. Alcohol was involved in one case. The average age of the patients was 55 years. 64 patients had an open procedure in addition to the external fixator, either bone grafting or open reduction and internal fixation. The fixators remained on for an average of 5.9 weeks. 68 patients (69 wrists) completed 1 year follow-up and were enrolled in this study. Fractures healed in all cases. The mean loss of height was 1.1 mm, the mean loss of inclination was 0.5 degrees, and the mean loss of volar tilt was 2.2°. Five patients had evidence of persistent intra-articular step off. The mean DASH score was 47 (minimun 30, maximum 113, SD ± 23). At 1 year, 46 individuals (68%) scored their outcome as measured on the Gartland scale as excellent, 16 (24%) were good, and 7 (10%) fair. Spearman rank correlation coefficients were used to determine that there was no statistically significant correlation between radiographic parameters or changes in radiographic measures and scores on the DASH or Gartland outcome measures.

Conclusion: Most patients lose some reduction following use of external fixation for distal radius fractures. There is little correlation between radiographic results and functional outcome following external fixation for the treatment of displaced distal radius fractures.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.