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Distal Radius Malunion Increases Risk of Persistent Disability 2 Years After Fracture: A Prospective Cohort Study

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Studies concerning the relationship between distal radius fracture malunion and a persistent arm-related disability have produced conflicting results.

Questions/purposes

We investigated (1) how arm-related disability changes during the first 2 years after a fracture and (2) whether fracture malunion causes persistent disability.

Methods

One hundred twenty-three patients with distal radius fractures, treated with closed reduction and casts or external or percutaneous pin fixations, completed the DASH questionnaire at baseline, 3 months, 6 months, 1 year, and 2 years after fracture. Radiographic measurements were made at 1 year. Using a definition of malunion as ulnar variance of 1 mm or more and dorsal tilt greater than 10°, the patients were classified into three groups: no malunion (n = 35), malunion involving either ulnar variance or dorsal tilt (n = 65), and malunion involving ulnar variance and dorsal tilt (n = 23). The changes in the DASH scores with time (baseline to 2 years), in relation to malunion, were analyzed using generalized estimating equations adjusted for age, sex, fracture type (extraarticular or intraarticular), and treatment method.

Results

The mean change in DASH scores from baseline to 2 years was worse for patients with malunions involving ulnar variance and dorsal tilt than for patients with no malunions (mean difference, 13; 95% CI, 1.4–25) and for patients with malunions involving either ulnar variance or dorsal tilt (mean difference, 13; 95% CI, 2.2–24).

Conclusion

After distal radius fracture, arm-related disabilities are more likely to persist at least 2 years in patients with fractures that healed with shortening and dorsal angulation than in patients with only shortening or dorsal angulation or without malunion.

Level of evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Mats Billsten for help with data acquisition and Gunilla Persson for administrative assistance.

Author information

Authors and Affiliations

  1. Department of Clinical Sciences Malmö, Lund University, Lund, Sweden

    Elisabeth Brogren MD

  2. Department of Hand Surgery, Skane University Hospital, Ing 59 A Plan 3, Malmö, Skane, Sweden, 20502

    Elisabeth Brogren MD

  3. Swedish National Competence Center for Musculoskeletal Disorders, Department of Orthopedics, Lund University Hospital, Lund, Sweden

    Philippe Wagner MSc

  4. Department of Radiology, Hässleholm Hospital, Hässleholm, Sweden

    Michael Petranek MD

  5. Department of Orthopedics Hässleholm-Kristianstad, Hässleholm Hospital, Hässleholm, Sweden

    Isam Atroshi MD, PhD

  6. Department of Clinical Sciences Lund, Lund University, Lund, Sweden

    Isam Atroshi MD, PhD

Authors
  1. Elisabeth Brogren MD
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  2. Philippe Wagner MSc
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  3. Michael Petranek MD
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  4. Isam Atroshi MD, PhD
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Corresponding author

Correspondence to Elisabeth Brogren MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Department of Orthopedics Hässleholm-Krisitianstad, Hässleholm Hospital, Hässleholm, Sweden.

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Brogren, E., Wagner, P., Petranek, M. et al. Distal Radius Malunion Increases Risk of Persistent Disability 2 Years After Fracture: A Prospective Cohort Study. Clin Orthop Relat Res 471, 1691–1697 (2013). https://doi.org/10.1007/s11999-012-2767-8

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  • DOI: https://doi.org/10.1007/s11999-012-2767-8

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