gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Association between radiological results and functional long-term (6.8 years) outcome in conservatively treated AO Type-C distal radius fractures

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  • presenting/speaker Leena Raudasoja - Helsinki University Hospital, Helsinki, Finland
  • Samuli Aspinen - Helsinki University Hospital, Helsinki, Finland
  • Heidi Vastamäki - Hospital Mehiläinen-Neo, Turku, Finland

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1637

doi: 10.3205/19ifssh0603, urn:nbn:de:0183-19ifssh06036

Published: February 6, 2020

© 2020 Raudasoja et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Our aim was to explore association between the radiological result and functional long-term outcome of conservatively treated distal radius fractures (AO type-C).

Methods: Sixty-three consecutive AO type-C distal radius fractures treated with reduction and cast immobilization were retrospectively collected from the trauma hospital database. Thirty-nine patients (mean age 53, 59% female) came for the clinical and radiological control visit mean 6.8 years after the treatment. Mean immobilization time was 5 weeks. The QDash -score and PRWE (Patient Rated Wrist Evaluation) served as functional outcome measures. Radius shortening, possible step-off in radius articular surface, and the dorsal tilt of distal radius were measured. The data was analyzed with Mann-Whitney U-test.

Results: In all wrists, the primary reduction result was considered acceptable according to the National Current Care Guidelines. After mean 6.8 years, exact anatomical result was only seen in 7 wrists (18%). According to the National guidelines in 24 wrists (62 %). Radius shortening of 2mm or more was found in 19 wrists with no association to PRWE (7.3 vs 4.8, p= 0,92) or QDash (11.4 vs 4.9, p =0,65). Only 3 patients had step-off on joint surface. Twelve wrists had dorsal tilt of 10° or more (one volar tilt of 24°) with no effect on PRWE or QDash (6.8 vs 5.6, p=0.63 and 11.4 vs 6.6, p=0.89). Together patients with dorsal tilt, step-off or shortening had worse PRWE compared to those with none (PRWE 6.3 vs 1.2, p=0.040), but no difference on QDash (8,4 vs 6,1, P= 0,157). Six complications emerged: four medianus entrapments, one EPL rupture, and one very stiff and painful wrist. These complications together showed no difference to PRWE (11,7 vs 4,6, p=0,64) or QDash (11.9 vs 6.7, p= 0.66). Neither did a fracture of ulnar styloid.

Conclusions: Most of the AO type-C distal radius fractures lost once gained posture during conservative treatment. Still in long-term follow up mere dorsal tilt or shortening of radius showed no association to functional outcome. Overall worsening of radiological parameters associated with worse PRWE but not QDASH. We acknowledge the small population size sets limitations and recommend further, larger controlled trials.