Pulp-to-palm distance is associated with inferior short-term outcome after combined plating for distal radius fractures

Abstract Distal radius fractures (DRF) are the most common fracture in adults. A tool is needed to identify patients who may need extra attention from the physical therapist during the rehabilitation process. The purpose of the study was to examine if pulp-to-palm distance (PTP) 4 weeks postoperatively is associated with wrist function 3 months postoperatively in patients undergoing combined plating for a complex DRF. This prospective study involved 53 patients. PTP was assessed by a physical therapist at the second visit, 4 weeks postoperatively. The 3-month follow-up visit consisted of evaluating the following outcomes: PRWE (Patient-Rated Wrist Evaluation), QuickDASH (Disabilities of the Arm, Shoulder and Hand), VAS pain scores, hand grip strength and wrist range of motion. All patients received the same amount of hand therapy. Patients with zero PTP at 4 weeks postoperative had a significantly better range of motion in wrist extension, flexion, radial deviation, ulnar deviation, hand grip strength and QuickDASH scores compared to patients with a PTP > 0 cm. VAS pain scores did not differ between the two groups. Patients with zero PTP at 4 weeks postoperative were more likely to have a better wrist function at 3 months postoperative compared to patients with measurable PTP. Based on this study's findings, measuring the PTP distance at 4 weeks postoperative could be useful for identifying patients in need of support during the rehabilitation process after DRF surgery. This could potentially improve the allocation of hand rehabilitation resources; screening patients postoperatively could help to begin relevant interventions.