Article
Worse outcome (DASH) at 12 months in 128 patients with combined radius-ulna metaphyseal fracture than radius fracture alone. A register study of 3666 patients. Need for Evidence Based Treatment Guidelines?
Search Medline for
Authors
-
Linnea Arvidsson
- Department of Orthopedics, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
-
Elin Österhed
- Department of Orthopedics, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
-
Marcus Landgren
- Department of Orthopedics, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
-
Antonio Abramo
- Dept. of Orthopedics/Hand Surgery, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
-
Magnus Tägil
- Dept. of Orthopedics/Hand Surgery, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| Published: | February 6, 2020 |
|---|
Outline
Text
Objectives/Interrogation: Up to six percent of the distal radius fractures (DRFs) have a concomitant distal ulna metaphyseal fracture (DUF), treatment algorithms are widely used for DRFs, but are missing for a concomitant DUF. In the present study we used our prospective register to describe and analyze patients with combined DRF and DUF.
Methods: Since 2002, all DRFs in patients 18 years and older at our hospital are prospectively registered and patient-reported outcome (DASH) recorded at one year. Between 2003 and 2012, 3666 patients (2833 women) were included in the register (mean age 62 (18-98) years). All patients with a DRF and a concomitant DUF were identified. The radiographs were evaluated and distal ulnar styloid fractures without metaphyseal extension were excluded. 128 patients (111 women) were classified according to AO:s Q Modifier for ulnar fractures, and the Biyani classification.
Patient characteristics, type of treatment and 1-year DASH were extracted from the register. Medical records were reviewed for current drug use and comorbidity according to the Charlson index. Statistical testing was made using the Mann-Whitney U test.
Results and Conclusions: The subjective outcome at one year was worse (DASH 23) in patients with DRF+DUF compared to the whole DRF cohort (DASH 9; p<0.001). 67/128 patients (52%) were treated conservatively in plaster, time in plaster varied between 4 and 8 weeks. 61/128 patients (48%) were operated for the DRF, of these 34 also had internal fixation of the DUF. Six different methods of internal fixation were used. The subjective outcome in the surgically and non-surgically treated DRF+DUF patients were similar (DASH 25 vs 26, ns).
The patients operated for both DRF and DUF were younger (mean 66 years) than the patients treated non-surgically for the DUF (mean 76 years, p<0.001). A high degree of comorbidity was found in the DRF+DUF cohort. 59% had a Charlson score for comorbidity of 1 or higher, 63% were using at least one drug and 29% met criteria for polypharmacy (an intake of 5 or more drugs regularly).
The patient group with both DRF and DUF had a substantially worse subjective outcome one year after the injury compared to patients with DRF alone. A majority of the patients were elderly with multiple health issues. We could not see that the choice of DUF treatment was done systematically. Additional studies are needed to determine how to best treat this subgroup of patients in the future.
