gms | German Medical Science

Objective: The Distal Radius Fracture (DRF) is the most common fracture in adults. After surgical management, extensive rehabilitation programs are common in order to restore function. Some patients are not able to fully move their fingers during the first month after a DRF-surgery (Pulp-to-palm distance=PTP).

Clinical Reasoning: The purpose of this study was to investigate if increased PTP 4 weeks after DRF surgery is associated with an inferior functional outcome 3 months postoperatively after DRF-surgery.

Materials and Methods: This prospective study involved 53 DRF-patients with intra-articular type C fractures according to the AO-classification. All patients were treated with combined volar and dorsal plating. The patients were assessed at 4 weeks and 3 months postoperatively according to PTP-distance, wrist range of motion, grip strength, VAS pain scores and self-assessed hand function. Rehabilitation was the same for all patients with focus on self-training instructions, regardless of individual finger and wrist status.

Results: 20 patients had a PTP > 0 cm 4 weeks after surgery. Three months after surgery, all patients had regained full finger motion. The group with PTP > 0 cm showed significantly inferior range of motion regarding dorsal- and volar flexion, radial- and ulnar deviation as well as grip strength and quick-DASH 3 months after surgery. Inferior outcomes for pro- and supination and PRWE-scores was seen but were not significant. Pain at rest and during activity showed no significant differences between the groups.

Conclusions: Impaired finger motion 4 weeks postoperatively is a significant predictor of functional outcome 3 months postoperatively in surgically treated DRFs. Measuring the PTP-distance can assist the physiotherapist in the allocation of rehabilitation resources.