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Association between radiographic and clinical outcomes following distal radial fractures: a prospective cohort study with 1-year follow-up in 366 patients
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.ORCID-id: 0000-0002-8727-9555
Department of Clinical Sciences, Danderyd Hospital (KIDS), Karolinska Institutet, Stockholm, Sweden.
Orthopaedic Unit, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden.
Department of Clinical Sciences, College of Medicine, University of Sharjah, United Arab Emirates.
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2023 (Engelska)Ingår i: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 105, nr 15, s. 1156-1167Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: Several studies of distal radial fractures have investigated final displacement and its association with clinical outcomes. There is still no consensus on the importance of radiographic outcomes, and published studies have not used the same criteria for acceptable alignment. Previous reports have involved the use of linear or dichotomized analyses.

METHODS: The present study included 438 patients who were managed with either reduction and cast immobilization or surgery for the treatment of distal radial fractures. Radiographic outcomes were determined on the basis of radiographs that were made 3 months after the injury. Clinical outcome was determined on the basis of the QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) score, range of motion, and grip strength at 1 year after the injury. Nonlinear relations were analyzed with cubic splines.

RESULTS: Three hundred and sixty-six patients (84%) had both radiographic and clinical follow-up. Seventy patients were lost to follow-up. The mean age was 57 years (range, 18 to 75 years), and 79% of the patients were female. Dorsal tilt was the radiographic parameter that was most strongly associated with the QuickDASH score, grip strength, and range of motion. We found nonlinear relations. Clinical outcomes were found to worsen with increasing dorsal tilt, with the cutoff value being approximately 5°.

CONCLUSIONS: We found that clinical outcomes following distal radial fractures have a nonlinear relationship with dorsal tilt, with worse outcomes being associated with increasing dorsal tilt. The decline in clinical outcome starts at 5°, but there is unlikely to be a noticeable difference in capability as measured with the QuickDASH until 20° of dorsal tilt (based on the minimum clinically important difference) in a population up to 75 years old.

LEVEL OF EVIDENCE: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Ort, förlag, år, upplaga, sidor
Wolters Kluwer, 2023. Vol. 105, nr 15, s. 1156-1167
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Ortopedi
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URN: urn:nbn:se:umu:diva-208252DOI: 10.2106/JBJS.22.01096ISI: 001041574300005PubMedID: 37172109Scopus ID: 2-s2.0-85166396145OAI: oai:DiVA.org:umu-208252DiVA, id: diva2:1756734
Tillgänglig från: 2023-05-15 Skapad: 2023-05-15 Senast uppdaterad: 2024-04-08Bibliografiskt granskad
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Schmidt, ViktorMukka, SebastianWadsten, Mats

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