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Pulp-to-palm distance after plate fixation of a distal radius fracture corresponds to functional outcome
Örebro University, School of Medical Sciences. Department of Hand and Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.ORCID iD: 0000-0001-5610-2063
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand and Orthopedic Surgery.ORCID iD: 0000-0002-4288-3134
Örebro University, School of Medical Sciences. Department of Hand and Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand and Orthopedic Surgery.ORCID iD: 0000-0002-5083-3591
2023 (English)In: Archives of physiotherapy, E-ISSN 2057-0082, Vol. 13, no 1, article id 6Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Several factors can influence the outcome after a distal radius fracture (DRF). The aim of this study was to assess whether postoperative pulp-to-palm (PTP) distance correlated with functional outcomes after plate fixation of DRF. MATERIALS &

METHODS: This is a secondary analysis of a randomized controlled trial aimed to investigate the effects of plate fixation in patients with type-C fractures. Subjects (N = 135) were divided into 2 groups based on PTP distance (equal to or higher than 0 cm) at 4 weeks postoperatively. Outcome measures were collected prospectively at 3, 6 and 12 months and included Patient-Rated Wrist Evaluation (PRWE), Quick Disabilities of the Arm Shoulder and Hand (QuickDASH) scores, wrist range of motion (ROM), Visual Analog Scale (VAS) pain scores, and hand grip strength.

RESULTS: Overall, at 3 and 6 months patients with PTP > 0 cm had significantly worse outcomes (PRWE, QuickDASH, wrist ROM) than those with PTP =0 cm. At 12 months, QuickDASH and wrist ROM were still significantly worse. In the volar-plating subgroup, patients with PTP > 0 cm had significantly worse wrist ROM and grip strength at 3 months, but no significant differences were found in subsequent follow-ups. In the combined-plating group, patients with PTP > 0 cm had significantly worse QuickDASH, wrist ROM and grip strength at 3 months. At 6 and 12 months, wrist ROM was still significantly worse.

CONCLUSIONS: Measurement of PTP distance appears to be useful to identify patients likely to have worse outcome after plating of a DRF. This could be a tool to improve the allocation of hand rehabilitation resources.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023. Vol. 13, no 1, article id 6
Keywords [en]
Distal radius fracture, Outcome, Patient-related outcome measures, Plating, Pulp-to-palm distance, Rehabilitation, Wrist function
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-105118DOI: 10.1186/s40945-023-00159-4ISI: 000999922000001PubMedID: 36941730Scopus ID: 2-s2.0-85150932411OAI: oai:DiVA.org:oru-105118DiVA, id: diva2:1745090
Available from: 2023-03-22 Created: 2023-03-22 Last updated: 2025-04-08Bibliographically approved
In thesis
1. On fractures of the distal radius: outcome analysis, the role of socioeconomic factors and surgical considerations
Open this publication in new window or tab >>On fractures of the distal radius: outcome analysis, the role of socioeconomic factors and surgical considerations
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Distal radius fractures (DRFs) are the most common fractures, yet many patients experience suboptimal recovery. Radiological parameters and patient factors guide treatment decisions, and surgical treatment is aimed at restoring the anatomy. However, the radiological result correlates poorly with the outcome, and so other factors impactingt he outcome must be considered. The present thesis addresses this matter by investigating the outcome and factors potentially influencing the outcome, such as socioeconomic factors, decreased finger motion, and surgical technique. Using data from the Swedish Fracture Register (SFR) and prospectively collected data, four studies were conducted:

• Study I: Analysed the epidemiology, treatment, and outcomes of intraarticular DRFs in the SFR.

• Study II: Examined decreased finger motion in relation to outcomes in 140 patients.

• Study III: Investigated the impact of socioeconomic factors on DRF recovery.

• Study IV: Assessed the risk of median neuropathy associated with the volar central approach in a cohort of 38 patients.

Key findings included the following: a considerable proportion of patients with intraarticular fractures experience disability 1 year after the fracture. Country of birth significantly affects DRF recovery, with non-European patients having higher risk of reported poor outcomes. Patients with decreased finger motion at 4 weeks post-surgery report worse outcomes up to 1 year after the surgery, suggesting its potential as a prognostic tool. The volar central approach carries a considerable risk of median neuropathy, and should be used only when optimal visualization of the distal radius is needed.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2025. p. 97
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 318
Keywords
distal radius fracture, volar locking plate, patient-reported outcome, socioeconomic factors, median nerve, nerve conduction study, epidemiology, pulp-to-palm distance
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-118896 (URN)9789175296432 (ISBN)9789175296449 (ISBN)
Public defence
2025-05-09, Örebro universitet, Campus USÖ, Tidefeltsalen, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2025-01-28 Created: 2025-01-28 Last updated: 2025-04-11Bibliographically approved

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Jakobsson, HugoLundqvist, EvaWretenberg, PerSagerfors, Marcus

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