1
|
Luk MLM, Chan ACM, Cho JSY, Ng DMT, Lam ICY, Yau ELK, Miller T, Pang MYC. Predictors of chronic pain and disability in patients treated conservatively after distal radius fracture: a prospective cohort study. INTERNATIONAL ORTHOPAEDICS 2023; 47:1535-1543. [PMID: 36973426 DOI: 10.1007/s00264-023-05785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To determine predictors of chronic pain and disability among patients with distal radius fractures (DRF) treated conservatively with closed reduction and cast immobilization. METHODS This was a prospective cohort study. Information on patient characteristics, post-reduction radiographic parameters, finger and wrist range of motion, psychological status (Hospital Anxiety and Depression Scale or HADS), pain (Numeric Rating Scale or NRS), and self-perceived disability (Disabilities of the Arm, Should, and Hand or DASH) were taken at baseline, cast removal, and 24 weeks. Differences in outcomes between time points were determined using analysis of variance. Multiple linear regressions were used to determine predictors of pain and disability at 24 weeks. RESULTS One hundred forty patients with DRF (70% women, age: 67.0 ± 17.9) completed 24 weeks of follow-up and were included in the analysis. NRS (off-cast), range of ulnar deviation (off-cast), and greater occupational demands were significant predictors of pain at week 24 (adjusted R2 = 0.331, p < 0.001). Significant predictors of perceived disability at week 24 were HADS (off cast), sex (female), dominant-hand injury, and range of ulnar deviation (off cast) (adjusted R2 = 0.265, p < 0.001). CONCLUSIONS Off-cast NRS and HADS scores are important modifiable predictors of patient-reported pain and disability at 24 weeks in patients with DRF. These factors should be targeted in the prevention of chronic pain and disability post-DRF.
Collapse
|
2
|
Ma HH, Huang HK, Yin CY, Huang YC, Chang MC, Wang JP. Radial distraction may reduce the incidence of ulnar-sided wrist pain in ulna-plus morphology intraoperatively following distal radius fractures fixation. BMC Musculoskelet Disord 2022; 23:580. [PMID: 35706022 PMCID: PMC9199129 DOI: 10.1186/s12891-022-05525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Fixed-angle plate fixation can be an effective treatment for distal radius fractures (DRFs). However, patients with existing ulnar positive variance might be at risk of developing symptoms of ulnar-sided wrist pain (USWP). Ulnar shortening osteotomy (USO) is one of the main treatment options for USWP. We hypothesized that a limited radial distraction at the fracture site at the time of surgery for DRF would be functionally equivalent to an indirect USO and that if this were done in a patient with an ulnar plus morphology it could potentially decrease the risk of USWP. METHODS This retrospective study was conducted at a single institution and all the surgeries were performed by single surgeon. A total of 136 patients (92 women and 44 men) with a mean age of 55 years were enrolled with 57 patients in the distraction group (from 2014 to 2017) and 79 patients (from 2011 to 2013) in the non-distraction group. Patients were assessed USWP. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Visual Analogue Scale (VAS) for pain, grip strength, and range of motion for the wrist. RESULTS The mean follow-up was 37.9 months (range, 28-61 months). The radiographs at postoperative 2-year follow-ups showed the mean ulnar positive variance was 1.3 mm (range, 1-2 mm) in the distraction group and 3.5 mm (range, 2-5 mm) in the non-distraction group. The average of the distraction length was 2.32 mm (range, 2-3 mm). At the 2-year follow-ups, USWP presented in 7% (four patients) in the distraction group, which was significantly less than the incidence of 28% (22 patients) in the non-distraction group. The distraction group exhibited significantly better DASH scores and grip strength and less subsequent ulnar-shortening osteotomy for ulnar-sided wrist pain. CONCLUSIONS The radial distraction procedure performed during DRFs fixation could possibly reduce the occurrence of postoperative USWP and improve the functional outcomes. LEVEL OF EVIDENCE Level III, Therapeutic.
Collapse
Affiliation(s)
- Hsuan-Hsiao Ma
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan, ROC.,Department of Orthopedics, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Division of Orthopaedics, Department of Surgery, Taipei Veterans General Hospital Taitung Branch, Taitung, Taiwan
| | - Hui-Kuang Huang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan, ROC.,Department of Orthopedics, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Department of Orthopedics, Chia-Yi Christian Hospital, Chiayi, Taiwan.,Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Cheng-Yu Yin
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan, ROC.,Department of Orthopedics, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chao Huang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan, ROC.,Department of Orthopedics, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chau Chang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan, ROC.,Department of Orthopedics, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Jung-Pan Wang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan, ROC. .,Department of Orthopedics, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
3
|
Yin CY, Huang HK, Fufa D, Wang JP. Radius distraction during volar plating of distal radius fractures may improve distal radioulnar joint stability at minimum 3-year follow-up: a retrospective case series study. BMC Musculoskelet Disord 2022; 23:181. [PMID: 35209885 PMCID: PMC8876376 DOI: 10.1186/s12891-022-05108-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 02/10/2022] [Indexed: 01/26/2023] Open
Abstract
Background The surgical technique of radius distraction for stabilization of distal radioulnar joint (DRUJ) if intraoperative DRUJ instability was found after the fixation of distal radius fracture has been previously described, but this surgical technique lacks clinical and radiographic effect in minimal 3 years follow-up. We therefore evaluated the clinical outcome and radiographic results of radius distraction in minimal 3 years follow-up as long-term evaluation. Methods We reviewed the case series of distal radius fracture with concomitant DRUJ instability receiving radius distraction from the senior author over a 5-year period (January 1st, 2013, to June 30th, 2017) retrospectively. Radius distraction during volar plating was performed by moving the volar plate distally via compression screw loosening/fastening to achieve firm endpoint on the dorsopalmar stress test. The evaluations of radiographic, including bone union time and ulnar variance, and clinical outcomes, including grading of DRUJ instability, NRS of wrist pain, DASH score, MMWS score, and range of motion of operated wrist at final follow-up, were performed at clinic as minimum 3-year follow-up; a total 34 patients had been evaluated. Results At minimal post-operative 36 months follow-up, all cases demonstrated acceptable wrist range of motion with stable DRUJs, low NRS of wrist pain (0.6, SD 0.7), and satisfactory DASH score (mean 9.1, SD 6.2) and MMWS score (mean 87, SD 10). There were no cases suffering from nonunion of distal radius. The mean ulnar variance of injured wrist and uninjured wrist were -1.2 mm and 0.2 mm, respectively (SD 1.0 and 0.6) with significant statistical difference. Conclusions Radius distraction during volar fixation of distal radius fracture should be considered if DRUJ instability was found by the dorsopalmar stress test intraoperatively, and the long-term DRUJ stability could be achieved by maintenance of normal-to-negative ulnar variance, with decreased wrist pain and satisfactory function outcome. Level of Evidence Therapeutic Level IV Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05108-z.
Collapse
Affiliation(s)
- Cheng-Yu Yin
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hui-Kuang Huang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Orthopaedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.,Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Duretti Fufa
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY, USA.,Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Jung-Pan Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
4
|
Ross PR, Chung KC. Instability in the Setting of Distal Radius Fractures: Diagnosis, Evaluation, and Treatment. Hand Clin 2020; 36:417-427. [PMID: 33040954 DOI: 10.1016/j.hcl.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Distal radius fractures with severe displacement or concomitant triangular fibrocartilage complex tears may be accompanied by distal radioulnar joint instability. Clinicians should examine the distal radioulnar joint closely when managing wrist fractures and treat coexisting instability appropriately. Chronic instability from distal radius malunion may require osteotomy or radioulnar ligament reconstruction. With proper management, most patients recover forearm stability and rotational motion after distal radius fracture.
Collapse
Affiliation(s)
- Phillip R Ross
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, 231 Albert Sabin Way, Cincinnati, OH 45267-0212, USA.
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA
| |
Collapse
|
5
|
Pang EQ, Douglass N, Behn A, Winterton M, Rainbow MJ, Kamal RN. The Relationship Between the Tensile and the Torsional Properties of the Native Scapholunate Ligament and Carpal Kinematics. J Hand Surg Am 2020; 45:456.e1-456.e7. [PMID: 31864824 DOI: 10.1016/j.jhsa.2019.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 08/23/2019] [Accepted: 10/15/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this exploratory study was to examine the relationship between the tensile and the torsional properties of the native scapholunate interosseous ligament (SLIL) and kinematics of the scaphoid and lunate of an intact wrist during passive radioulnar deviation. METHODS Eight fresh-frozen cadaveric specimens were transected at the elbow joint and loaded into a custom jig. Kinematic data of the scaphoid and lunate were acquired in a simulated resting condition for 3 wrist positions-neutral, 10° radial deviation, and 30° ulnar deviation-using infrared-emitting rigid body trackers. The SLIL bone-ligament-bone complex was then resected and loaded on a materials testing machine. Specimens underwent cyclic torsional and tensile testing and SLIL tensile and torsional laxity were evaluated. Correlations between scaphoid and lunate rotations and SLIL tensile and torsional properties were determined using Pearson correlation coefficients. RESULTS Ulnar deviation of both the scaphoid and the lunate were found to decrease as the laxity of SLIL in torsion increased. In addition, the ratio of lunate flexion-extension to radial-ulnar deviation was found to increase with increased SLIL torsional rotation. CONCLUSIONS Our findings support the theory that there is a relationship between scapholunate kinematics and laxity at the level of the interosseous ligaments. CLINICAL RELEVANCE Laxity and, specifically, the tensile and torsional properties of an individual's native SLIL should guide reconstruction using a graft material that more closely replicates the individual's native SLIL properties.
Collapse
Affiliation(s)
- Eric Quan Pang
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | - Nathan Douglass
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | - Anthony Behn
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | - Matthew Winterton
- Department of Orthopaedic Surgery, Penn Medicine University City, Penn Musculoskeletal Center, Philadelphia, PA
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, Ontario, Canada
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA.
| |
Collapse
|