A cohort study of one-year functional and radiographic outcomes following intra-articular distal radius fractures.
BACKGROUND
The purpose of this study was to describe the outcomes of a series of patients followed prospectively after intra-articular distal radius fractures.


METHODS
One hundred forty-eight patients with intra-articular fractures (mean age, 47 years; age range, 44-54 years; gender distribution, 60 males and 88 females) were treated with cast only, arthroscopy/closed reduction plus pins, arthroscopy/closed reduction with external fixation, open reduction and internal fixation (ORIF) alone, and ORIF with external fixation according to surgeon preference and fracture characteristics. The 1-year outcomes across the groups were measured radiographically (n = 148) and functionally (n = 113; 1-year Wrist Outcome Measure score, Grip Strength, SF-36, and PRWE scores).


RESULTS
Radiographically, the groups had statistically significant differences in radial inclination, volar tilt, intra-articular step-off, and radial shortening in the pre-treatment X-rays. However, following treatment, treatment groups demonstrated no difference statistically in their follow-up radiographic measures. One-year PRWE scores were found to be statistically different across groups. Across groups, the ORIF-alone treatment group had the highest PRWE score reflecting greatest amount of pain and disability. One-year wrist outcome measure scores and grip strength scores were also found to be significantly different across treatment groups. The general health status as measured by the SF-36 was not found to be different across treatment groups.


CONCLUSIONS
These findings are consistent with treatment by indication; suboptimal ORIF outcomes may reflect older practice patterns with dorsal plating. A randomized control trial that compares treatments controlling for fracture severity and studies that develop formal clinical prediction rules for treatment assignment are needed.
Clinical Research Laboratories, Hand Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada ; School of Rehabilitation Sciences, McMaster University, Hamilton, ON Canada.
Emily A
EA
Lalone
Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON Canada ; Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada.
Vaishnav
V
Rajgopal
Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON Canada ; Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada ; Clinical Research Laboratories, Hand Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada.
James
J
Roth
Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON Canada ; Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada ; Clinical Research Laboratories, Hand Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada.
Ruby
R
Grewal
Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada ; Clinical Research Laboratories, Hand Hand and Upper Limb Centre, St. Joseph's Healthcare, London, ON Canada ; School of Rehabilitation Sciences, McMaster University, Hamilton, ON Canada ; The Lawson Health Research Institute, P.O. Box 5777, London, ON N6A 4L6 Canada.
Joy C
JC
MacDermid
Distal radius; Fracture; Impairments; Intra-articular; Patient-reported outcomes; Radiograph; Treatment