gms | German Medical Science

Objectives/Interrogation: To evaluate repercussion on the hand of Distal Radial Fracture Nonunion and analize hand functional improvement after Radius stabilization.

Methods: 15 patients with Distal Radius NonUnion were treated between 2005 and 2012. Inclusion criteria were: distal radius established non union; preoperative clinical and functional evaluation from patients'charts; surgical fixation-stabilization of the Nonunion and minimum follow up of 3 years. Initial X rays were AP and lateral. CT scan was taken in those cases with articular fracture or for distal radial fragment size evaluation. Final X rays evaluated consolidation. Preoperative and final evaluation data included: DASH score, Visual Analogic Scale (VAS) both for pain and function and Swanson Scale for pain; Signs of Complex Regional Pain Syndrome (CRPS) - pain at rest and finger stiffness. The posibility of closing the fist was recorded before surgery and at final follow up.

Results: 10 patients met inclusion criteria: 7 were female and 3 male. The average age was 65 years-old (52-85). Preoperative results: pain was VAS 7.2 (8 of 10 patients had VAS 7 or higher). Four had pain at rest, 2 with light tasks, 3 with moderate efforts and 1 with strong efforts. 3 of 10 patients could make a fist reaching the palm of their hand with the tip of the fingers. Six had signs of CRPS. DASH averaged 62 (22-89). In six cases radius non union was treated with radial reconstruction. Four cases had a salvage procedure: two Radio-Lunate-Scaphoid arthrodesis and two Total Wrist Arthrodesis.

Final follow up was 75 months (43 to 125). Pain resulted in VAS 0.3 (0 to 1). Five patients had no pain at all, and 5 had light pain with great efforts. All could make a complete fist touching the palm with all the finger pulps and no one had signs of CRPS. Final DASH averaged 11 (0 to 20). Final functional VAS averaged 8 (5 to 10). Three patients complicated and had a second surgery to obtain bone fusion. Finally, all nonunions and arthrodesis consolidated.

Conclusion: Distal Radius Non Union carries a significant functional impairment, not only in the wrist itself but even more in the affected hand: pain, stiffness, subjective dysfunction, and Complex Regional Pain Syndrome affecting activities of daily living. Achieving Radius stabilization, either by Radius reconstruction or by partial or total wrist arthrodesis, resulted in significant improvement in hand function and in pain relief.