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A Prospective Study Of Functional Outcome Following Intra-articular Fracture Of Distal Radius In Adults -- A Comparison Between External Fixation And Internal.

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Presentation on theme: "A Prospective Study Of Functional Outcome Following Intra-articular Fracture Of Distal Radius In Adults -- A Comparison Between External Fixation And Internal."— Presentation transcript:

1 A Prospective Study Of Functional Outcome Following Intra-articular Fracture Of Distal Radius In Adults -- A Comparison Between External Fixation And Internal Plating Xu Weixin Lim Beng Hai Alphonsus Cheong Chloe Seow

2 Introduction External fixation and internal plating are two common techniques used in the local hospitals for treatment of unstable distal radius fracture in the adults Most of the studies on results of surgical intervention reported encouraging results (Catalano et al J Bone Joint Surg 79A: ; Rikli et al 1996 J Bone Joint Surg 78B:588-92; Jakim et al J Bone Joint Surg 73B:302-6) However, they were not done in a prospective, randomized manner

3 Introduction Most of the randomized studies were comparing the results of casting with surgical treatments in a mixed-age population (Ludvigsen et al. Acta Orthop Scand 1997; 68: ; Howard et al J Bone Joint Surg 1989; 71B: 68-73; Huchinson et al J Hand Surg 1995; 20B: ; Stein et al Acta Orthop Scand 1990; 61: ) This study evaluated the external fixation and internal plating for the treatment of unstable distal radius fractures in a randomized prospective manner

4 Aim of Study To compare the functional outcomes following external fixation and internal plating in the management of unstable intra-articular distal radius fractures, using both subjective and objective outcome measures.

5 Methodology Inclusion criteria Age: Patients with closed comminuted intra-articular fracture of the distal radius (AO classification of C2-C3) requiring surgical fixation Operation performed within three days post- injury

6 Methodology Exclusion criteria Pathological fracture Old fracture on the same extremity Patients who are not likely to follow up to one year Complicated cases which requires to following different rehabilitation protocols (i.e. flap resurfacing, tendon repair/reconstruction and replantation done on the same injured extremity)

7 Methodology Written consent was obtained from the patients The subjects were randomly allocated to the two different surgical treatment groups by the randomization envelop system The patients were referred to hand therapy 2 days after operation following standardized rehabilitation intervention

8 Pre-op (case 1)

9 Pre-op (case 2)

10 Post-op (case 1)

11 Post-op (Case 2)

12 Methodology Demographic information Ext FixInt Plate Number17 (M:14 F:4)22 (M:18 F:4) Mean age R hand dominance 17 (100%)22 (100%) R side injury8 (47%)9 (41%)

13 Methodology Occupation Ext FixInt Plate Sedentary7 (41%)11 (50%) Manual10 (59%)11 (50%)

14 Methodology Ethnic distribution (int. plating):  Chinese: 16 (72%)  Malay: 2 (5%)  Indian: 3 (14%)  Others: 1 (5%)

15 Methodology Ethnic distribution (Ext. fixation):  Chinese: 13 (76%)  Malay: 0 (0%)  Indian: 3 (18%)  Others: 1 (6%)

16 Methodology Functional evaluation: outcomes were collected at 2 month, 3 month, 6 month and 1 year post injury  active range of motion of the wrist and forearm  grip and pinch strength  patient rated wrist evaluation (PRWE)  modified Green and O'Brien scoring system.

17 Methodology Standardized rehabilitation protocols were followed after both surgical interventions Ext FixInt Plate 0-4 weeksFinger AROM; C- bar splint if necessary Interval wrist splint 2 weeks; gentle wrist AROM 4-6 weeksWrist splint for 2 weeks after R/O ext fixator; gentle wrist AROM Continue wrist AROM & PROM; gentle strengthening

18 Methodology Ext FixInt Plate 6-8 weeksContinue wrist AROM & PROM Continue strengthening 8-12 weeksStart stretching & Strengthening Work conditioning 12 weeks onwards Work conditioning

19 Results Mean PRWE Score Over Time

20 Results Mean Modified Green and O'Brien Score Over Time

21 Results Pearson Chi-square test were used, and showed no significant differences between groups with regards to age, hand dominance, fracture side, cause of injury, occupation and associated injuries (P>.05) One-way ANOVA test were used to compare the functional outcomes between the two groups (P<.05)  Dorsi-flexion at 2-month post injury (P=.029)  Radiual deviation at 2-month post injury (P=.002)  Radiual deviation at 3-month post injury (P=.001) No statically significant deference was detected from other variables

22 Discussion Both internal plating and external fixation showed good functional results for treating unstable extra-articular distal radius fracture Internal plating provides earlier active rehabilitation and earlier return of certain range of motion of the wrist as compared with external fixation Further data analysis is need to look into radiographic characteristics and complications between these two groups

23


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