Is there a correlation between functional results and radiographic findings in patients with distal radius fracture A0 type A3 treated with volar locking plate or external fixator?
Trine LudvigsenKjell MatreNils VettiPer Martin KristoffersenMonika Kolskår ToppeRakel Sif GudmundsdottirYngvar KrukhaugEva DybvikJonas Meling Fevang
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The aim of this study was to test the hypothesis that precise restoration of distal radius fractures is correlated to better patient-reported outcome.The correlation between radiographic results and functional outcome was explored in 156 patients with extra-articular distal radius fractures included in a multicenter, randomized controlled trial comparing 2 surgical interventions, Volar Locking Plate or External Fixator. The primary functional outcome was the Patient Rated Wrist and Hand Evaluation score (PRWHE). Radiographically we assessed volar tilt, radial inclination, radial height, ulnar variance, and the presence of ulnar styloid fracture. The Pearson correlation analysis was used to estimate correlations between parameters.At 1-year follow-up the mean difference in radiographic findings compared with the uninjured side (min, max) was: reduced volar tilt 5.3° (-15°, 25°), reduced radial inclination 2.3° (-6°, 12°), radial height 1.3 mm (-4 mm, 7 mm), and ulnar variance -0.5 mm (-6 mm, 3 mm). Overall, we found no correlation between radiographic parameters and the PRWHE at 1-year follow-up within the whole group, regardless of which treatment was chosen. At the time of injury 53% (N = 80) had sustained an additional ulnar styloid fracture. After 1 year this fracture was still radiographically present in 31% (N = 43) of the patients. No correlation between PRWHE score and the presence of an ulnar styloid fracture at 1-year follow-up was found.We found no correlation between functional outcome (PRWHE) and radiographic findings after 1 year in patients operated on with a Volar Locking Plate or External Fixator. Patient-specific factors were more important than radiographic measurements in this study group.Level of evidence: Therapeutic Level 2Trial registration: Norway: National Committee for Medical and Health Research Ethics 213/555ClinicalTrials.gov ID: NCT01904084Randomization of first patient: 02.09.2013.Keywords:
Distal radius fracture
Wrist-hand orthoses (WHOs) are prescribed for a range of musculoskeletal/neurological conditions to optimise wrist/hand position at rest and enhance performance by controlling its range of motion (ROM), improving alignment, reducing pain, and optimising grip strength. The objective of this research was to study the efficacy and functionality of ten commercially available WHOs on wrist ROM and grip strength.Randomised comparative functional study of the wrist/hand with and without WHOs.Ten right-handed female participants presenting with no underlying condition nor pain affecting the wrist/hand which could influence motion or grip strength. Each participant randomly tested ten WHOs; one per week, for 10 weeks.The primary outcome was to ascertain the impact of WHOs on wrist resting position and flexion, extension, radial, and ulnar deviation. A secondary outcome was the impact of the WHOs on maximum grip strength and associated wrist position when this was attained.From the 2,400 tests performed it was clear that no WHO performed effectively or consistently across participants. The optimally performing WHO for flexion control was #3 restricting 86.7%, #4 restricting 76.7% of extension, #9 restricting 83.5% of radial deviation, and #4 maximally restricting ulnar deviation. A grip strength reduction was observed with all WHOs, and ranged from 1.7% (#6) to 34.2% (#4).WHOs did not limit movement sufficiently to successfully manage any condition requiring motion restriction associated with pain relief. The array of motion control recorded might be a contributing factor for the current conflicting evidence of efficacy for WHOs. Any detrimental impact on grip strength will influence the types of activities undertaken by the wearer. The design aspects impacting wrist motion and grip strength are multifactorial, including: WHO geometry; the presence of a volar bar; material of construction; strap design; and quality of fit. This study raises questions regarding the efficacy of current designs of prefabricated WHOs which have remained unchanged for several decades but continue to be used globally without a robust evidence-base to inform clinical practise and the prescription of these devices. These findings justify the need to re-design WHOs with the goal of meeting users' needs.
Ulnar deviation
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This study quantifies the effect of a simultaneous grip on wrist strength. It was hypothesized that wrist flexion strength increases with an increasing grip and wrist extension strength decreases with an increasing grip. Twelve subjects performed maximum wrist flexion and extension exertions with a different level of simultaneous grip – minimum, preferred, and maximum. Wrist flexion strength increased 34% and wrist extension strength decreased 10% from minimum to maximum grip. This shows that measure of wrist strength for assessing strength capabilities or the efficacy of hand surgeries or rehabilitation programs requires control of finger flexor activities to ensure consistent and relevant results. When opening a bottle in an outward direction (right hand thread), wrist extension strength may be significantly limited by a simultaneous grip due to muscle antagonism. When twisting a fragile or uncomfortable object, reduced finger flexor activities can limit wrist flexion strength.
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ABSTRACT Background: Grip strength after wrist arthrodesis is reported to be significantly less than normal. One of the reasons suggested for this decrease in grip strength is that the arthrodesis was performed in a suboptimal position. However, there is no consensus on the ideal position of wrist fusion. There is a paucity of studies evaluating the effect of various fixed positions of the wrist on grip strength and therefore, there is no guide regarding the ideal position of wrist fusion. The authors’ aim was to determine the grip strength in various fixed positions of the wrist and subsequently to find out in which position of wrist fusion the grip strength would be maximal. Materials and Methods: One hundred healthy adults participated in the study. For the purpose of this study, the authors constructed splints to hold the wrist in five different fixed positions: 45, 30 and 15 degrees of wrist extension, neutral and 30 degrees of wrist flexion. The grip strength in all the participants was measured bilaterally, first without a splint and then with each splint sequentially. Results: The average grip strength without the splint was 34.3 kg for right and 32.3 kg for the left hand. Grip strength decreased by 19–25% when the wrist was splinted. The maximum average grip strength with a splint on was recorded at 45 degrees of extension (27.9 kg for right and 26.3 kg for left side). There was a gradual increase in the grip strength with increase in wrist extension but the difference was not statistically significant (P = 0.29). The grip strength was significantly less in flexed position of the wrist (P < 0.001).
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Objective To analyze the clinical treatment effect of combined external fixator in the treatment of unstable distal radius fractures combined with external fixation. Methods Choosing 85 cases of unstable distal radius fractures from March 2011 to March 2012 in our hospital and dividing them into control group and treatment group, control group treated with plaster fixation for fracture, treatment group treated with combined external fixator. Results For unstable distal radius fracture, using combined external fixator for treatment, the clinical effect was better than that of control group, the patients were fixed with plaster. ConclusionCombined external fixator in the treatment of unstable distal radius fracture has a good effect and stability, so it is worthy of clinical promotion.
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Background: - Prolonged usage of smartphone may lead to pain around thumb and wrist. Thus, there is a need to assess the muscles strength of wrist and hand among smartphone users. Method: - 140 (70 males and 70 females) young college going adults with age group between 17-23 years were randomly selected for the study. Wrist muscle strength and power grip strength were assessed using hand held dynamometer. Pinch grip strength was assessed using pinchometer. Results: - Peak mean strength of wrist flexor was 10.40(4.43) Kg, wrist extensor was 10.48(4.79) Kg, power grip was 30.73(13.69) Kg and pinch grip was 5.58(1.59) Kg. Spearman’s correlation coefficient ranged from 0.6 to 1 between wrist and grip strength. Conclusion: - Currently there is no adverse effect of smartphone usage on pinch and power grip but wrist muscles are found to be weak. Key words: Wrist muscles, Grip, Handheld dynamometer, Pinchometer
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This study investigated the effect of the lateral counterforce armband on wrist extension and grip strength, and pain of 14 subjects with tennis elbow. Dynametric strength tests and pain analogue scale assessments were obtained on the affected and unaffected arms of subjects, while wearing the armband and without wearing the armband. Use of the armband produced parallel effects in both the affected and unaffected arms, i.e., increases in wrist extension and grip strength. The greatest effects were seen in the affected arm. There was a statistically significant increase in wrist extension strength with the armband on relative to without the armband. The increase in wrist extension strength approximately doubled the increase in grip strength for both arms, indicating the armband's greater influence on wrist extension. Although there was a low negative correlation between changes in pain and strength, it was not statistically significant.
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Grip strength after wrist arthrodesis is reported to be significantly less than normal. One of the reasons suggested for this decrease in grip strength is that the arthrodesis was performed in a suboptimal position. However, there is no consensus on the ideal position of wrist fusion. There is a paucity of studies evaluating the effect of various fixed positions of the wrist on grip strength and therefore, there is no guide regarding the ideal position of wrist fusion. The authors' aim was to determine the grip strength in various fixed positions of the wrist and subsequently to find out in which position of wrist fusion the grip strength would be maximal.One hundred healthy adults participated in the study. For the purpose of this study, the authors constructed splints to hold the wrist in five different fixed positions: 45, 30 and 15 degrees of wrist extension, neutral and 30 degrees of wrist flexion. The grip strength in all the participants was measured bilaterally, first without a splint and then with each splint sequentially.The average grip strength without the splint was 34.3 kg for right and 32.3 kg for the left hand. Grip strength decreased by 19-25% when the wrist was splinted. The maximum average grip strength with a splint on was recorded at 45 degrees of extension (27.9 kg for right and 26.3 kg for left side). There was a gradual increase in the grip strength with increase in wrist extension but the difference was not statistically significant (P = 0.29). The grip strength was significantly less in flexed position of the wrist (P < 0.001).
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Objective:To evaluate the results of agedness intra-articular fractures of the distal radius treated with wrist external fixator.Methods:From April 2002 to May 2007,47 wrist external fixators were performed in 47 agedness intra-articular fractures of the distal radius,and 42 fractures were followed up at average 24(7-50)months.The patients were evaluated with Jakim wrist score.Results:42 fractures got union,and 83.33% of patients had excellent or good results by evaluated with Jakim wrist score.Conclusion:Wrist external fixator is fairly well for agedness intra-articular fractures of the distal radius with simple procedure,less complications,and good clinical results.
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Objective To investigate the therapeutic effects of external fixators on distal radius fracture.Method 34 distal radius fractures in 32 patients were treated with unilateral external fixator and then the therapeutic effects were analyzed.Results It was from 4 to 8 weeks with a mean time of 5.5 weeks for fracture to heal up.During the 10～24 months of follow up(16 months on the average),the results were excellent in 23 fractures in 22 cases,good in 8 cases,fair in 3 fractures in 2 cases.The excellent and good rate was 93.8%.Conclusion The unilateral external fixator is an effective way in the therapy of distal radius fracture.It has superiority of little trauma,convenient fixing and is beneficial for postoperative functional exercise of hand.
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