Sat., 10/20/07 Upper Extremity, Paper #59, 11:19 am OTA-2007
Patient Outcome Five Years following Colles’ Fracture
Jessica E. Farmer, MD (n); Abizar Aladin, MD (n); Steve A. Earnshaw, MD (n);
Chris Boulton (n); Chris G. Moran, MD (n);
Queen’s Medical Centre, Nottingham, United Kingdom
Purpose: The management of Colles’ fracture remains controversial and developments in plate technology have increased interest in operative fixation. The majority of patients are treated nonoperatively, yet there are few medium- or long-term outcome studies. The aim of this study was to evaluate medium-term outcome of a cohort of patients who previously received nonoperative treatment in a plaster cast.
Methods: 236 patients entered 2 previous prospective, randomized control studies comparing closed reduction techniques (n = 135) or plaster cast type (n = 135). Both studies showed no difference in clinical or radiological outcome between groups and 70% of patients had fracture malunion. However, early clinical outcomes were good. All patients now have at least 5 years follow-up and 60 of the cohort have died (26.3%). The remaining 176 patients were contacted by mail and asked to complete 2 validated patient-based questionnaires: a modified Patient Evaluation Measure (Gliatis et al 2000) and a quickDASH. 112 replies were received.
Results: The mean age of patients is 67 years (range, 23-91 years). 31 patients are employed and 57 retired. The mean quickDASH score was 14 (standard deviation 20.4) and 77% of patients scored less than 20, suggesting excellent clinical outcome. 84% of patients had no wrist pain or experienced pain once a month or less while 8% of patients experienced daily pain. All Patient Evaluation Measures have shown a median visual analog score of 12 or less (0 = excellent, 100 = terrible). The best score was for pain (median 4; IQR 2-12) and the worst for grip strength (median 12; IQR 4 – 41).
No differences have been found in any outcome score between patients less than and those greater than 50 years of age. Furthermore, no differences have been found in outcome scores between employed and retired patients. No radiological outcome 5 weeks after injury correlated with any outcome score, except for dorsal tilt, which correlated with poor wrist movement (P = 0.036).
Conclusion and Significance: These results show a very good subjective outcome 5 years after nonoperative management of Colles’ fracture, and do not show any significant correlation between radiological and functional outcome. These results demonstrate that management of Colles’ fracture in a plaster cast can give a good medium-term outcome.
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