Thurs., 10/14/10 Upper Extremity, Paper #30, 3:25 pm OTA-2010
Hand Stiffness following Distal Radius Fractures: Who Gets It and Is It a Functional Problem?
Steve K. Lee, MD1; Nader Paksima, DO1; Nikola Lekic, BA2; Allissa Zingman, BA3;
Michael Walsh, PhD4; Kenneth A. Egol, MD1;
1NYU Hospital for Joint Diseases, New York, New York, USA;
2Georgetown University, Washington, District of Columbia, USA;
3University of Maryland, College Park, Maryland, USA;
4SUNY Downstate, Brooklyn, New York, USA
Purpose: The purpose of this study was to identify predictors for hand stiffness following distal radius fractures and to identify the association between hand stiffness and pain, functional outcomes, and work status.
Methods: 352 patients with distal radius fractures were followed prospectively. Baseline demographics were obtained at presentation. Outcome parameters obtained at regular intervals included wrist and hand range of motion, radiographs, visual analog pain scales, and Disability of the Arm, Shoulder and Hand (DASH) questionnaires. Stiffness was defined as tip-to-palm distance greater than 1 cm for all fingers based on the distribution of data. Data was analyzed using the Student t test and Fisher exact tests to evaluate for predictors of stiffness and to compare the effects of stiffness on outcomes.
Results: Predictors for hand stiffness included advanced age (P = 0.009) and higher osteoarthritis grade (P < 0.001) but not OTA fracture classification type, articular step-off, ulnar variance, gender, or educational level. Patients with hand stiffness had worse functional outcomes. Stiff patients were significantly less likely to have returned to full-duty work at 3-month (P < 0.001), 6-month (P = .007), and 12-month (P = 0.047) intervals. Grip strength was weaker for stiff patients at 3 (P < 0.001), 6 (P < 0.001), and 12 months (P = 0.035) postoperatively. There was no significant difference between pain level or overall DASH score of stiff versus non-stiff patients; however, stiff patients scored significantly lower on hand dexterity–based DASH questions, such as ability to cut food, at 3 (P < 0.001) and 6 (P = 0.015) months postoperatively.
Conclusion: Advanced patient age and preexisting osteoarthrosis were positive predictors for postoperative hand stiffness. Fracture type did not influence the development of hand stiffness. Hand stiffness had a significant effect on recovery and return to work and on grip strength.
Alphabetical Disclosure Listing (292K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.