Outcome Measurement for Distal Radius Fractures

Comparative Biomechanical Analysis of Kirschner Wire Fixation in Dorsally Displaced Distal Radius Fractures

OBJECTIVE

This study aims to evaluate and compare the biomechanical performance of two Kirschner (K) wire configurations-the intra-focal and interfragmentary techniques-for the fixation of dorsally displaced distal radius fractures. The study also assesses the impact of K-wire diameter (1.6 mm vs. 2.0 mm) on mechanical stability.

METHODS

Sixty fresh turkey tarsometatarsus bones were selected and divided into four groups based on the K-wire configuration and diameter used. Fractures were created at standardized locations, and each bone was stabilized using either the intra-focal also known as modified Kapandji (Ka) or interfragmentary technique. Mechanical testing, including axial compression and flexion tests, was performed to assess the biomechanical stability of each configuration.

RESULTS

The interfragmentary configuration consistently demonstrated superior biomechanical performance compared to the intra-focal technique. Specifically, the use of 2.0 mm K-wires resulted in significantly higher axial stiffness (13.28 MPa) and load at break (3070 N) compared to the 1.5 mm wires. Confidence intervals further supported the robustness of these findings. The interfragmentary technique, especially with thicker K-wires, provided greater load-bearing capacity and stiffness.

CONCLUSION

The interfragmentary technique with 2.0 mm K-wires offers superior mechanical stability compared to the intra-focal technique, making it the preferred choice for stabilizing comminuted extra-articular distal radius fractures. These findings suggest that adopting this technique may reduce the risk of postoperative complications such as fracture displacement or malunion. Further research involving osteoporotic bone models and clinical trials is recommended to validate these findings in real-world settings.

Factors influencing functioning after volar locking plate fixation of distal radius fractures: a scoping review of 148 studies

BACKGROUND AND PURPOSE

A better understanding of factors that influence functioning may improve the identification of patients with distal radius fractures (DRFs) who need hand therapy. The purpose of this scoping review was to provide a comprehensive overview of factors that have been evaluated for their influence on hand functioning following volar plate fixation of DRFs.

MATERIAL AND METHODS

6 databases were searched from 2005 to 2021 for publications regarding surgical treatment for a DRF with a volar locking plate. Included studies evaluated demographic, perioperative, and postoperative factors within the 6 weeks post-surgery for their influence on functioning at least 3 months post-surgery. Functioning was assessed with patient-reported outcome measures. The factors were categorized into themes and mapped to the International Classification of Functioning, Disability and Health (ICF).

RESULTS

148 studies were included. 708 factors were categorized into 39 themes (e.g. pain) and mapped to the ICF components. The themes were primarily mapped to "body functions and structures" (n = 26) and rarely to "activities and participation" (n = 5). Fracture type (n = 40), age (n = 38), and sex (n = 22) were the most frequently evaluated factors.

CONCLUSION

This scoping review identified an extensive number of factors evaluated within 6 weeks after surgery for their influence on functioning at least 3 months after volar plate fixation of a DRF and the existing research has primarily evaluated factors related to "body functions and structures," with limited focus on factors related to "activities and participation."

Association between perceived and objective hand-wrist function in distal radius fracture

The relationship between patient-reported outcome measures and objective measures is important for understanding patient expectations. The aim of this study was to investigate the relationship of each section of the Michigan Hand Outcomes Questionnaire (MHQ) to objective measurements in patients with distal radius fracture (DRF). Eighty-four patients who were treated operatively or non-operatively for DRF were included. Injury severity was assessed by the Modified Hand Injury Severity Score. Joint motion was assessed at 6 and 12 weeks and grip strength at 12 weeks after non-operative treatment or surgery. The MHQ was used to assess hand functionality. The relationships between measurements were analyzed by Spearman correlation analysis. Statistical significance was set at p < 0.05. Fifty-one patients (60.7%) were women and 33 (39.3%) men. Mean age was 48.17 ± 12.26 (range, 20-64) years. Fifty-two (61.9%) patients were treated surgically and 32 (38.1%) non-operatively. Forearm pronation-supination and wrist flexion and ulnar deviation at week 6 and forearm pronation-supination, wrist extension and radial deviation at week 12 correlated with MHQ scores, unlike wrist extension and radial deviation at week 6 and flexion and ulnar deviation at week 12. Gross and fine grip strength at week 12 correlated with MHQ, except for the overall hand function, work performance and pain subsections. The MHQ subsections correlated with joint motion and grip strength in the early period after DRF. These findings clarified patient expectations in the early period.