Is there a correlation between functional results and radiographic findings in patients with distal radius fracture A0 type A3 treated with volar locking plate or external fixator?

Abstract

The aim of this study was to test the hypothesis that precise restoration of distal radius fractures is correlated to better patient-reported outcome.Methods: The correlation between radiographic results and functional outcome was explored in 156 patients with extra-articular distal radius fractures included in a multicenter, randomized controlled trial comparing 2 surgical interventions, Volar Locking Plate or External Fixator. The primary functional outcome was the Patient Rated Wrist and Hand Evaluation score (PRWHE). Radiographically we assessed volar tilt, radial inclination, radial height, ulnar variance, and the presence of ulnar styloid fracture. The Pearson correlation analysis was used to estimate correlations between parameters.Results: At 1-year follow-up the mean difference in radiographic findings compared with the uninjured side (min, max) was: reduced volar tilt 5.3°(À15°, 25°), reduced radial inclination 2.3°(À6°, 12°), radial height 1.3 mm (À4 mm, 7 mm), and ulnar variance À0.5 mm (À6 mm, 3 mm). Overall, we found no correlation between radiographic parameters and the PRWHE at 1-year follow-up within the whole group, regardless of which treatment was chosen. At the time of injury 53% (N = 80) had sustained an additional ulnar styloid fracture. After 1 year this fracture was still radiographically present in 31% (N = 43) of the patients. No correlation between PRWHE score and the presence of an ulnar styloid fracture at 1-year follow-up was found.Conclusions: We found no correlation between functional outcome (PRWHE) and radiographic findings after 1 year in patients operated on with a Volar Locking Plate or External Fixator. Patient-specific factors were more important than radiographic measurements in this study group.

Comparação de características sociodemográficas e radiográficas no tratamento de fratura de rádio distal: Cirurgiões de mão versus não especialistas

“…3,5,8,14,17 A IR atingida em nossa amostra foi de 18,9°nas mulheres e 19,5°nos homens e a IV de 11,4°; estes dados ficaram abaixo do encontrado na literatura. [2][3][4][5][7][8][9]11,14 O método de fixação pode ser um dos responsáveis pela diferença constatada, embora os estudos tenham demonstrado não existir dife-rença dos resultados radiográficos relacionados com o método de fixação. 1,2 Ademais, há contradição na relação entre os resultados radiográficos e a função, principalmente em idosos cuja demanda é menor.…”

“…16 The goal of the orthopedist is to restore wrist function and mobility. 2,3,16 However, there is no consensus on the ideal treatment, considering age, activity level, occupation, bone quality, fracture type, and quality of life. 1,2,10,12,16 Assessing treatment outcomes is difficult because therapeutic success is multifactorial.…”

“…16 O objetivo do ortopedista é restaurar a função e mobilidade do punho. 2,3,16 Porém, não existe consenso sobre o tratamento ideal, devendo ser levados em consideração: idade, grau de atividade, ocupação, qualidade óssea, tipo de fratura e qualidade de vida. 1,2,10,12,16 É difícil avaliar o resultado do tratamento, uma vez que o sucesso terapêutico é multifatorial.…”

Does time to surgery for distal radius fractures impact clinical and radiographic outcomes? A systematic literature review

“…Furthermore, it is well established that radiographic findings do not necessarily correlate with functional outcomes for distal radius fracture injuries. [36][37][38] Ultimately, the inclusion of both subjective and objective measures when evaluating the impact of time to surgery will provide improved patient-centered care and insight into success as defined by the patient.…”

“…For instance, patients achieving acceptable range of motion or patients not requiring revision operations may still be unable to carry out activities of daily living or return to work. Furthermore, it is well established that radiographic findings do not necessarily correlate with functional outcomes for distal radius fracture injuries 36–38 . Ultimately, the inclusion of both subjective and objective measures when evaluating the impact of time to surgery will provide improved patient-centered care and insight into success as defined by the patient.…”