Introduction
Distal radius fractures are one of the commonest fracture. Good long-term outcome depends on factors like type of fracture and type of treatment used. Therefore, the outcome is not same in all cases after treatment. Treatment should help to restore normal anatomy of wrist with good radiological outcome, prevent loss of reduction and functional rehabilitation of patient. [1,2]
Materials and Methods
We retrospectively studied 120 patients with intra-articular and extra articular distal radius fracture managed with various modalities of treatment at Department of Orthopaedics, SAIMS, Indore. Aims and objective of study was to find correlation between radiological and functional outcome of distal radius
fractures treated by different modalities of treatment. Inclusion and exclusion criteria were as follows:
Inclusion criteria: Males and females 25 to 80 years of age
Exclusion criteria:
1. Patients with open fractures,
2. Fracture of bilateral distal radius.
3. Associated Fractures shaft of radius or ulna.
The patients who visited the hospital with extra and intra-articular distal radius fractures, who had been managed surgically and came for follow-up (at least six months) were taken up for study after taking consent from them for the study. Post-operative x rays of the wrist in antero-posterior and lateral views were taken.
Radial inclination, volar tilt, residual step, radial height and ulnar variance were analysed. Fracture classification was done based on AO classification. [2] Pain and function score were graded according to PRWE (Patient Rated Wrist Evaluation) [3] (which has 50 points each for pain and function score, being 0 denotes least pain and least difficulty in performing function) and overall results were recorded according to Demerit point system Score [4,5] as poor, fair, good and excellent. Functional grading was made depending on pain, mobility, work, grip strength. Radiological grading was made based on radial height, radial Inclination, volar tilt, ulnar variance and intra articular step.
Results
We retrospectively studied 120 Patients, with intra-articular and extra articular distal radius fracture in which 30 each were managed by volar plating and JESS fixator, 30 by percutaneous pinning and 30 conservatively. Most-common-age group was between 40-60 yrs. which constituted 28.8% of cases. There were 73 males (65%) and 47 females (35%). RTA was the most common mode of injury in our study in young patients and trivial fall in geriatric patients followed by fall from height and assault.
AO type C1(31.25%) was the most common fracture followed by, B1(20.8%), C2(20%), B3(12.5%), & B2(8%) andC3 5% Mean pain score: There were less pain scores among the patients who retained the radial inclination (P=0.01), radial height (p<0.01), in patients with no intraarticular step (P=0.053), neutral ulnar variance.
Mean function score: There were less function scores among the patients who retained the radial inclination (p<0.01), radial length (p<0.01), and in patients with no intraarticular step (P=0.003). Among the patients who had intra articular step function scores were less with the patient who had less than 2 mm step(P<.01). Some patients had good function score in spite of radiological parameters being affected. Those were mainly patients with less physical demands. Excellent results were seen in 60% of cases, Good in 15%, fair in 15% and poor in10% of cases. Affection of radiological parameters (radial inclination, radial length, Intra articular step and palmar tilt, ulnar variance) had effect on final outcome.
Excellent results (77% of excellent results were among less than 40 years age group) were more in younger age group (p<0.01). Post-surgery good and excellent results were more among patient where radiological parameters were restored. Better outcome was seen in patients where post-surgery number of radiological parameters restored were more in number (p<0.01).
Discussion
Distal radius fractures are one of the most common fractures treated. Outcome mainly depends on factors like type of fracture and modality used. Treatment should aim to restore radiological parameters, reduction and functional status of patient. Studies have been done to study relationship between anatomical reconstruction and the functional outcome. [1,6]
Functional and radiological outcome, after management in our study depended on age, fracture type, modality of treatment. The time of union was less in younger patients.
Basset concluded that Range of motion was significantly higher in cases that underwent ORIF. Scores (general, work, appearance, final, and MHOC) were significantly higher in cases that underwent ORIF. In subjects who underwent ORIF, pain score was significantly lower. [7] similar observations were made in this study.
Jakim I in his prospective study of 132 patients with an average age of 35 years, with unstable intra-articular fractures of the distal radius treated by external fixator reported only 15 cases required limited open reduction. 83% of patients had good or excellent results. There was a statistically significant correlation between the severity of the fracture and the clinical outcome, irrespective of radiological restoration. [8] In this study mean pain score and mean function score were better in internal fixation group as compared to external fixation group (21.3 and 19.8 respectively as compared to 11.7 and 12.8 in ORIF group) Articular and soft-tissue damage following violent compressive forces may lead to a degree of functional impairment.
