Can Generic Outcome Questionnaires Replace QuickDASH in Monitoring Clinical Outcome Following Surgical Treatment of Distal Radius Fractures?

Purpose In contrast to region-specific patient-reported outcome measures (PROMs), generic PROMs can be argued to have an added benefit of enabling cost-utility analyses and allowing for comparisons to be made across different conditions. The aim of this study was to assess the responsiveness and strength of the association between region-specific and generic PROMs in patients treated operatively for a displaced intra-articular distal radius fracture. Methods Over a 4-year period, 166 patients aged 18–70 years with a displaced intra-articular fracture of the distal radius were treated with either a volar locking plate or external fixation augmented by K-wires and followed-up prospectively for 2 years. The main outcome measure was the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, but EuroQol-5D (EQ-5D) and 36-Item Short Form Survey (SF-36) were also employed. The associations between the QuickDASH score and EQ-5D and between the QuickDASH score and SF-36 were assessed using a linear mixed model. Results There was a significant positive association between the QuickDASH score and EQ-5D and between the QuickDASH score and SF-36 throughout the follow-up period, although wide dispersion existed for the outcome measures at an individual level. However, the association between the QuickDASH score and SF-36 was significantly weaker at 6 weeks and 3 months than that at baseline, indicating that EQ-5D more closely mirrors changes in the QuickDASH score in the early postoperative period. Conclusions The study demonstrates that the QuickDASH score and EQ-5D correlate well on a group level, but large individual variations exist. The SF-36 had decreased sensitivity for the changes in the QuickDASH score at 6 weeks and 3 months. Clinical relevance Our findings indicate that generic PROMs cannot fully replace the region-specific QuickDASH score when evaluating the outcomes of distal radius fractures

Early Mobilization and Physiotherapy Vs. Late Mobilization and Home Exercises After ORIF of Distal Radial Fractures

Background: Volar locking plates have permitted early mobilization, omitting the need for prolonged cast immobilization, after distal radial fractures (DRFs). However, the type of rehabilitation following plate fixation of DRFs remains an unresolved issue. The purpose of this study was to evaluate the effect of physiotherapy after volar plate fixation of DRFs. At a 2-year follow-up, we compared the results of immediate physiotherapy (early mobilization) with those of home exercises following 2 weeks in a dorsal plaster splint (late mobilization). Methods: Patients with an extra-articular DRF scheduled for open reduction and internal fixation (ORIF) with a volar locking plate were evaluated for eligibility for enrollment in the study. The patients were randomized into 2 groups: (1) early mobilization and physiotherapy and (1) late mobilization and home exercise. In the early mobilization group, the plaster splint was removed after 2 to 3 days. During the first 3 months, the patients met with the institution’s physiotherapist every other week. The late mobilization group wore the dorsal splint for 2 weeks and only met with our physiotherapist once, when the splint was removed. This group was provided with a home physiotherapy program and instructed to perform home exercises on their own. Results: One hundred and nineteen patients were included in the study. The 2 groups had similar demographics with respect to age, sex, and baseline values. Seven patients were lost to follow-up. No clinically relevant difference in scores on the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire was found between the 2 groups at any of the follow-up evaluations. The largest difference in the QuickDASH score was found at 6 weeks, when the early mobilization group had a mean score of 30 compared with a mean of 37 in the late mobilization group (p = 0.05). Conclusions: Early mobilization and multiple physiotherapy visits did not improve wrist function compared with standard treatment of 2 weeks in a dorsal plaster splint, a single physiotherapy visit, and home exercises. Early mobilization following ORIF of an extra-articular DRF is safe

Epidemiology of distal radius fracture in Akershus, Norway, in 2010–2011

Background Several studies published over the last decade indicate an increased incidence of distal radius fractures (DRF). With Norway having one of the highest reported incidence of DRFs, we conducted a study to assess the epidemiology of DRFs and its treatment in the catchment area of Akershus University Hospital (AHUS). Methods Patients 16 years or older who presented to AHUS with an acute DRF during the years 2010 and 2011 were prospectively recorded and classified according to the AO fracture classification system. The mechanism of injury and treatment modality were noted. Results Overall, 1565 patients with an acute DRF presented to the institution in 2010–2011, of which 1134 (72%) were women. The overall annual incidence was 19.7 per 10,000 inhabitants 16 years or older. Women had an exponential increase in incidence after the age of 50, though the incidence for both genders peaked after the age of 80 years. There was an even distribution between extra- and intra-articular fractures. Falling while walking outside was the most common mechanism of injury. Of the 1565 registered, 418 (26.7%) patients underwent surgery, with a volar locking plate being the preferred surgical option in 77% of the cases. Conclusion The overall incidence of distal radius fractures was lower in our study than earlier reports from Norway. Postmenopausal women had a higher risk of fracture than the other groups, and low-energy injuries were most dominant. 26.7% were treated operatively, which is higher than earlier reports, and might reflect an increasing preference for surgical treatment

Five-Year follow-up results of a rondomized controlled study comparing intramedullary nailing With plate fixation of completely displaced midshaft fractures of the clavicle in adults

Background: Surgical management of completely displaced midshaft fractures of the clavicle is becoming more frequent, although long-term follow-up with Level-I evidence is scarce. Plate fixation (PF) of comminuted fractures provides faster functional recovery than elastic stable intramedullary nailing (ESIN). The 12-month follow-up of this randomized controlled trial, published previously, found no clinical differences at that time on the group level, but subtle differences on the subgroup level indicated that the results after closed ESIN were better than those after open ESIN. The primary aim of the study reported here was to compare the long-term clinical outcomes and sequelae after open reduction with those after closed reduction and to help surgeons develop a treatment strategy of either PF or ESIN for selected patients. Methods: At a median follow-up of 66 months (range, 49 to 89 months), the 123 patients in the original study were invited to an online secure survey. We used the survey results to compare the PF and ESIN treatment arms and to perform predetermined subgroup analyses of closed compared with open ESIN in relation to Disabilities of the Arm, Shoulder and Hand (DASH) score, pain assessment, and implant removal. Results: The questionnaire was completed by 114 (93%) of the 123 patients. There were no differences between the 2 treatment arms with regard to the DASH score (ESIN, 3.1 +/- 7.0 and PF, 3.7 +/- 7.5; p = 0.9). The 27 patients who had been treated with closed ESIN had a significantly superior DASH score compared with the 27 patients who had been treated with open ESIN (closed, 0.7 +/- 1.4 and open, 5.2 +/- 8.9; p = 0.015) and compared with the patients who had been treated with PF (closed ESIN, 0.7 +/- 1.4 and PF, 3.9 +/- 7.5; p = 0.002). Patients who had been treated with closed ESIN also reported fewer sequelae than patients who had been treated with open ESIN or PF. Conclusions: The results of this study, combined with those of our prior 1-year follow-up of the same patients, indicate that it seems to be advantageous to perform closed ESIN. The long-term results after PF were similar to those after open ESIN, but PF resulted in faster functional recovery and fewer patients needing to have the implant removed. Therefore, if open reduction is necessary for a comminuted fracture, it seems that the advantages of the minimally invasive ESIN procedure are lost, and the surgeon should consider conversion to PF. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence