van Es E M, Dijkhof M, Souer J S, van Ewijk F J, Hoogendam L, Slijper H P, Selles R W, Colaris J W
Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
Hand and Wrist Center, Xpert Clinics, Amsterdam, the Netherlands.
Heliyon. 2024 Apr 16;10(9):e29570. doi: 10.1016/j.heliyon.2024.e29570. eCollection 2024 May 15.
Distal radius malunion can result in pain and functional complaints. One of the functional problems that can affect daily life is impaired forearm rotation. The primary aim of this study was to investigate the effect of corrective osteotomy for distal radius malunion on forearm rotation at 12 months after surgery. We secondarily studied the effect on grip strength, radiological measurements, and patient-reported outcome measurements (PROMs).
This cohort study analysed prospectively collected data of adult patients with symptomatic distal radius malunion. All patients underwent corrective osteotomy for malunion and were followed for 1 year. We measured forearm rotation (pronation and supination) and grip strength and analysed radiographs. PROMs consisted of the Patient-Rated Hand/Wrist Evaluation (PRWHE) questionnaire, Visual Analogue Scale for pain, and satisfaction with hand function.
Preoperative total forearm rotation was 112° (SD: 34°), of which supination of 49° (SD: 25°) was more impaired than pronation of 63° (SD: 17°). Twelve months after surgery, an unpaired Student's -test showed a significant improvement of total forearm rotation to 142° (SD: 17°) (p < 0.05). Pronation improved to 72° (SD: 10°), and supination to 69° (SD: 13°) (p < 0.05). Grip strength, PROMs, as well as inclination and volar tilt on radiographs improved significantly during the first year after surgery (p < 0.05).
In patients with reduced forearm rotation due to distal radius malunion, corrective osteotomy is an effective treatment that significantly improves forearm rotation. In addition, this intervention improves grip strength, the PRWHE-score, pain, and satisfaction with hand function.
桡骨远端畸形愈合可导致疼痛和功能障碍。影响日常生活的功能问题之一是前臂旋转功能受损。本研究的主要目的是调查桡骨远端畸形愈合矫正截骨术对术后12个月时前臂旋转功能的影响。其次，我们研究了对握力、影像学测量和患者报告结局指标（PROMs）的影响。
本队列研究分析了前瞻性收集的有症状的桡骨远端畸形愈合成年患者的数据。所有患者均接受了畸形愈合矫正截骨术，并随访1年。我们测量了前臂旋转（旋前和旋后）和握力，并分析了X线片。PROMs包括患者自评手/腕评估（PRWHE）问卷、疼痛视觉模拟量表以及对手功能的满意度。
术前前臂总旋转角度为112°（标准差：34°），其中旋后49°（标准差：25°）比旋前63°（标准差：17°）受损更严重。术后12个月，采用非配对t检验显示前臂总旋转角度显著改善至142°（标准差：17°）（p<0.05）。旋前改善至72°（标准差：10°），旋后改善至69°（标准差：13°）（p<0.05）。术后第一年，握力、PROMs以及X线片上的倾斜度和掌倾角均有显著改善（p<0.05）。
对于因桡骨远端畸形愈合导致前臂旋转功能降低的患者，矫正截骨术是一种有效的治疗方法，可显著改善前臂旋转功能。此外，该干预措施还可改善握力、PRWHE评分、疼痛以及对手功能的满意度。
