THE FUNCTIONAL OUTCOME AFTER DISTAL RADIUS FRACTURE

Abstract

Aim: To investigate factors that influence outcomes one year after distal radial fractures To investigate how deformity (radiologically), functional outcome and patient satisfaction affect one another.

Background: Identifying the factors that influence outcome in DRF is important in anticipating and treating patients with potentially correctable factors that may affect recovery. Previous studies have looked at different sub-sets of the DRF group most often with patient reported outcomes. We have reviewed a large consecutive group of DRF looking at which factors influenced the outcomes.

Methods: Data on 640 distal radial fractures was prospectively recorded over a 24 month period. The database was reviewed and validated. Mechanism of injury, hand dominance and occupation were noted. Initial, post reduction, one week, 6 week and one year x-rays were taken. The volar and dorsal shortening, tilt and angulation were recorded. Any operative intervention or complication was noted.

At one year follow up functional testing was performed including range of movement. This tested for grip strength, multiple postional strengths and a functional score looking at activities of daily living.

Results: Prediction of functional outcome was significantly associated with age, volar communition, dorsal angulation and pain. The grip strength after a distal radial fracture is significantly stronger in dominant side fractures compared with non dominant, in younger patients and those without dorsal communition.

We also showed that fractures that are most likely to malunite show a significantly poorer functional outcome and weaker grip strength.

Conclusion: This study identifies factors that predict the functional outcome in Distal Radial fractures. Although many assumptions are made that certain fractures lead to poorer results this has rarely been shown in such a large, diverse group of DRFs.

In an age where patients and practitioners strive to ever increasing levels of knowledge this study allows us to counsel patients in their likely functional outcomes more accurately.