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Indian Journal of Orthopaedics Surgery


“Do Radiographic parameters predict Functional Outcome in Distal end Radius Fracture?”


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Author Details: Vikram Ashok Rajguru, Swarup-Masih Sohanlal Daniel, Amit Kale

Volume : 2

Issue : 3

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 240

Article End Page : 245


Abstract

Background: Lower end radius fractures are among the most common fractures of the upper limb and accounts for 15-20% of orthopedic admissions in hospitals. Management these fractures continues to be a therapeutic problem and challenge. Though there are various treatment options described so far; still there is lacunae in the literature, regarding accurate treatment modality, particularly in case of unstable fractures. Various clinical and biomechanical studies have shown the benefits of restoring anatomical reduction. However other studies have demonstrated that restoring normal anatomy does not offer better functional outcomes. While achieving good fracture alignment may be significant, the actual functional importance of anatomical reduction is controversial. The assumption that functional outcome is better by restoration of anatomy is argued.
Most orthopaedicians accept the fact that anatomical alignment is preferable, but the threshold for acceptable malunion and the long-term outcome of anatomical reduction on functional outcome and patient related satisfaction remain to be evaluated.
The study had been taken up to disclose the correlation between anatomical and functional outcome in these patients with distal radius fracture.
Objective: To examine association of radiographic parameters of distal radius fracture and objective (ROM, Grip strength) and subjective (PRWE) functional outcome.
Study design and setting: A observational study on management of adult patients with distal radial fractures presenting at Deenanath Mangeshkar Hospital and Research Centre, Pune from October 2013 to December 2015.
Patients and methods: This study carried out on the patients with intra-articular and extra-articular fractures of the distal end radius as per selection criteria and after taking a written informed consent. Outcome measures were assessed both objectively and subjectively. Objective assessment included a radiographic score determined by measuring the radial length, radial angle and dorsal angle on wrist radiographs; and the wrist function by measuring the range of motion and hand-grip strength. Subjective assessment was done using wrist pain and disability based on the patient rated wrist evaluation (PRWE) score. Data were analyzed using SPSS v20.
Results and analysis: The mean age of our study population (49) was 53 years (20 – 90 years), and 33 patients (67%) were female. Twenty eight fractures (57.1%) were of the dominant hand. Non-operative (14) and operative treatments (35) were used. Majority of patients had a good radiographic score (61%), while 6% had a poor score. Sixty five patients (65%) had a good functional objective score, and 21% had an excellent score. In the subjective assessment of pain and disability, the PRWE score was highest in the 41-60 years age group at 38/100 and least in those at 60 and above years (32/100; p= 0.004). There was a positive correlation (p =0.000) between radiographic assessment and the objective functional assessment in younger age group. There was no correlation between the radiographic score and the subjective assessment (p =0.319). Grip strength was a significant predictor of disability (PRWE score).
Conclusion: The majority of the patients had a good radiographic score which correlated positively with the objective functional score, especially in the younger patients; however, a good radiographic score does not seem to positively affect the subjective functional outcome. The patient’s age is an important factor in the overall patient satisfaction regardless of the radiographic and the objective functional scores, hence to be considered during planning of treatment options.