Session XII - Upper Extremity
The Thirty-Eight Year Outcome of Distal Radial Fractures in Young Adults
Purpose: We conducted a clinical and radiologic review of 119 distal radial fractures sustained in young adults to assess the long-term development of symptomatic arthritis and functional impairment.
Methods: 801 patients who had sustained a distal radial fracture between 1960 and 1968 were identified from the hospital records. Of these, 119 who were below the age of 40 (mean 25 years) at the time of injury were reviewed at an average of 38 years (range, 33-42) later. All but one patient had been treated in a Colles plaster with or without manipulation for between 5 and 6 weeks. All underwent a detailed physical examination, completed a self-reported validated questionnaire, and underwent standardized posteroanterior and lateral radiographs of both wrists.
Results: No patient had changed occupation as a result of the fracture and none reported significant limitation of function. No salvage procedures had been performed. 89% reported troublesome pain once per month or less. Flexion-extension was significantly reduced in the fractured wrist but by only 7°. Grip strength was also significantly reduced but by an average of only 2 kg. 90% of fractures had malunited in at least one radiologic parameter and the fractured wrists had significantly more radiologic arthrosis than the uninjured side. Logistic regression and ordinal logistic regression analysis demonstrated no relation between either malunion or radiologic arthrosis and the objective or subjective outcome measures. Objective and subjective measures were, however, significantly related. The strongest predictor of fracture outcome was the function of the uninjured wrist.
Conclusions/Significance: Malunion was well tolerated in this group of patients. We demonstrated no significant incidence of symptomatic posttraumatic osteoarthritis.