Division of Orthopaedics, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; RebalanceMD, Victoria, British Columbia, Canada; Department Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
J Hand Surg Am. 2024 Sep;49(9):827-845. doi: 10.1016/j.jhsa.2024.01.012.
To document the change of clinical (wrist motion and grip strength) measurements and Patient-Rated Wrist Evaluation (PRWE) scores at 9 weeks and 3, 6, and 12 months after distal radius fracture (DRF) in women 50 years and older with exclusively isolated, displaced, and low-energy DRFs treated by either closed and/or open reduction and to relate these outcomes to their radiographic results.
In this retrospective single-institution cohort study, patients' post-DRF clinical measurements and PRWE scores were prospectively collected from December 2007 through September 2018 and stratified according to their final radiographic values of volar/dorsal tilt, ulnar variance, and radial inclination.
Of the 1,319 women identified, 1,126 (85%) were treated nonsurgically, and 193 (15%) were treated operatively. At 12 months, patients averaged restoration (ratio of injured and uninjured sides' values) of 96% pronation, 95% extension, 91% supination, 81% flexion, and 80% (77% nondominant, 85% dominant) grip strength. The mean PRWE score was 39.5 at week 9 and 14.4 at 12 months with 54% of patients scoring <10 and 13% scoring zero. The mean volar/dorsal tilt, ulnar variance, and radial inclination values in those treated nonsurgically were 1.4° dorsal, +3.9 mm, and 18.0°, respectively. Analogous values in patients treated surgically were 6° volar, +2.6 mm, and 22°, respectively. Volar tilt ≥25°, dorsal tilt >10°, ulnar variance >+7.5 mm, and radial inclination ≤13° were thresholds beyond which motion and grip strength were reduced and/or PRWE scores increased. In general, older patients experienced more residual deformity and were less likely to have undergone surgery.
Generally, outcomes were satisfactory for patients with radiographic results within identified thresholds for acceptable fracture reduction. Outcomes were significantly less favorable for patients with radiographic results beyond these thresholds; for these patients, early surgical intervention should be considered. Low-energy DRFs should prompt bone density investigation.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic 2b.
记录 50 岁及以上女性单纯性、移位性、低能量桡骨远端骨折（DRF）患者在骨折后 9 周和 3、6、12 个月时的临床（腕关节运动和握力）测量值和患者腕关节评估（PRWE）评分的变化，并将这些结果与他们的放射学结果相关联。
在这项回顾性单中心队列研究中，从 2007 年 12 月至 2018 年 9 月前瞻性收集患者 DRF 后的临床测量值和 PRWE 评分，并根据其最终的掌背侧倾斜、尺侧差异和桡侧倾斜的放射学值进行分层。
在确定的 1319 名女性中，1126 名（85%）接受了非手术治疗，193 名（15%）接受了手术治疗。在 12 个月时，患者的旋前平均恢复率（受伤侧与未受伤侧的比值）为 96%，伸展为 95%，旋后为 91%，屈曲为 81%，握力为 80%（非优势侧为 77%，优势侧为 85%）。9 周时 PRWE 平均得分为 39.5，12 个月时为 14.4，其中 54%的患者得分<10，13%的患者得分为 0。在非手术治疗的患者中，掌背侧倾斜、尺侧差异和桡侧倾斜的平均数值分别为 1.4°背侧、+3.9 毫米和 18.0°。在接受手术治疗的患者中，这些数值分别为 6°掌侧、+2.6 毫米和 22°。掌侧倾斜≥25°、背侧倾斜>10°、尺侧差异>+7.5 毫米和桡侧倾斜≤13°是运动和握力降低和/或 PRWE 评分增加的阈值。一般来说，年龄较大的患者有更多的残余畸形，且不太可能接受手术。
一般来说，对于放射学结果在可接受的骨折复位阈值内的患者，结果是令人满意的。对于放射学结果超过这些阈值的患者，结果明显较差；对于这些患者，应考虑早期手术干预。低能量 DRF 应提示进行骨密度检查。
治疗性研究 2b 级。
