Predictors of wrist function and health status after operative treatment of fractures of the distal radius

Reliability and validity of the Danish version of the disabilities of arm, shoulder, and hand questionnaire in patients with fractured wrists

The disabilities of arm, shoulder, and hand (DASH) questionnaire is a 30-item region-specific questionnaire that is used to measure the effect of treatment of the upper extremity. The purpose of this study was to assess the reliability of, and validate, the Danish version of the DASH score in patients with fractured wrists. Sixty patients were studied. We investigated internal consistency and test-retest reliability, convergent validity, content validity and responsiveness. Time to complete questionnaire was 11 minutes and two questionnaires were not usable. The internal consistency was sufficient (Cronbach's alpha 0.96 and intraclass correlation coefficient 0.89). The difference in the mean was 4.6 (CI: 0.48 to 8.72, p = 0.03). Convergent validity at first and last control was high for both pain, 0.46 and 0.40 respectively, and for physical mobility, 0.64 and 0.65 respectively, indicating that results confirmed other similar scores. We conclude that the Danish version of the 30-item DASH questionnaire is valid and practical for patients with fractured wrists.

Assessing results after distal radius fracture treatment: a comparison of objective and subjective tools

OBJECTIVES

Functional outcomes following distal radius fractures are directly influenced by the choice of outcome assessment instruments used. Our objective was to compare scoring systems in measuring patient functional outcomes and to determine which scoring system compared most favorably with the widely used Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.

METHODS

In all, 108 patients between May 2004 and November 2006 were treated operatively following distal radius fractures. Follow-up was at 3 months, 6 months, 1 year, and 2 years postsurgery, during which anatomical and functional assessments were performed. Patient outcomes were recorded using DASH, Green and O'Brien system, Gartland and Werley system, and Sarmiento radiological scoring system.

RESULTS

There was a stronger correlation between the Green and O'Brien scoring system and DASH (r = -.54) than Gartland and Werley and DASH (r = .44). The Green and O'Brien scoring system was more demanding so patients rated "excellent" or "good" had better functional outcome than those bearing the same grade in the Gartland and Werley system. Nonetheless, the Green and O'Brien score and Gartland and Werley score showed good correlation with each other (r = .66). The Sarmiento radiological score had no significant correlation with any of the other scoring systems. Significant predictors of the DASH score were function (r = .42), power grip (r = .41), pain (r = .37), and range of motion (r = .28).

CONCLUSION

The Green and O'Brien scoring system correlated most strongly with the DASH score. Radiological scoring (reflecting anatomical deformity) was not significantly correlated with functional outcome. While subjective parameters "pain" and "function" are influenced by psychosocial factors and thus highly variable, it is paramount to include subjective tools in outcome assessment in future studies on wrist fractures.

Relationship between distal radius fracture malunion and arm-related disability: a prospective population-based cohort study with 1-year follow-up

Background

Distal radius fracture is a common injury and may result in substantial dysfunction and pain. The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability.

Methods

The prospective population-based cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast (55 patients) or external and/or percutaneous pin fixation (88 patients). The patients were evaluated with the disabilities of the arm, shoulder and hand (DASH) questionnaire at baseline (concerning disabilities before fracture) and one year after fracture. The 1-year follow-up included the SF-12 health status questionnaire and clinical and radiographic examinations. Patients were classified into three hypothesized severity categories based on fracture malunion; no malunion, malunion involving either dorsal tilt (>10 degrees) or ulnar variance (≥1 mm), and combined malunion involving both dorsal tilt and ulnar variance. Multivariate regression analyses were performed to determine the relationship between the 1-year DASH score and malunion and the relative risk (RR) of obtaining DASH score ≥15 and the number needed to harm (NNH) were calculated.

Results

The mean DASH score at one year after fracture was significantly higher by a minimum of 10 points with each malunion severity category. The RR for persistent disability was 2.5 if the fracture healed with malunion involving either dorsal tilt or ulnar variance and 3.7 if the fracture healed with combined malunion. The NNH was 2.5 (95% CI 1.8-5.4). Malunion had a statistically significant relationship with worse SF-12 score (physical health) and grip strength.

Conclusion

Malunion after distal radius fracture was associated with higher arm-related disability regardless of age.

New Assessment of Forearm Strength: Reliability and Validity

OBJECTIVE. The objective was to determine the reliability of a portable forearm strength hydraulic dynamometer with a doorknob handle and assess its validity compared with a Cybex 6000 (Cybex International, Inc., Medway, MA) isometric torque assessment.

METHOD. Eighteen volunteers (with a total of 30 forearms) participated in this one-session methodological study to determine the intra- and interrater reliability and criterion validity of a forearm dynamometer.

RESULTS. Intrarater reliability for both assessors for pronation was (intraclass correlation coefficient [ICC]3,1 = .937–.961) and for supination was (ICC3,1 = .923–.968). Interrater reliability for pronation was ICC3,2 = .927 and for supination was ICC3,2 = .847. Criterion validity of the Baseline hydraulic dynamometer (Fabrication Enterprises Inc., White Plains, NY) compared with the Cybex 6000 was .574–.664 for pronation and .749–.750 for supination.

CONCLUSION. The Baseline hydraulic dynamometer with a more functional doorknob handle had good intra- and interrater reliability and demonstrated moderate validity compared with Cybex 6000 strength testing.

Neuropathic pain in patients with upper-extremity nerve injury

PURPOSE

The purpose of this review was to present an analysis of the literature of the outcome studies reported in patients following traumatic upper-extremity (UE) nerve injuries (excluding amputation), to assess the presence of an association between neuropathic pain and outcome in patients following traumatic UE nerve injuries, and to provide recommendations for inclusion of more comprehensive outcome measures by clinicians who treat these patients.

SUMMARY OF KEY POINTS

A Medline and CINAHL literature search retrieved 48 articles. This review identified very few studies of patients with peripheral nerve injury that reported neuropathic pain. When pain was reported, visual analogue or numeric rating scales were most frequently used; standardized questionnaires measuring pain or psychosocial function were rarely administered. Recent evidence shows substantial long-term disability and pain in patients following peripheral nerve injury.

RECOMMENDATION

To better understand neuropathic pain in patients following peripheral nerve injury, future outcome studies should include valid, reliable measures of physical impairment, pain, disability, health-related quality of life, and psychosocial functioning.

Outcomes of percutaneous pinning in treatment of distal radius fractures

Distal radius fractures are among the most common bone fractures all over the world. Close reduction and fixation by percutaneous pinning is a less invasive method comparing with other open surgeries. This study aims at evaluating the functional outcome of this treatment in distal radius fractures. In this prospective study, 50 patients with distal radius fractures underwent percutaneous pinning during a 16 month period in Tabriz Shohada Hospital. Follow-up for 3 months was possible in 48 (96%) patients. Possible complications (such as infection, nonunion, pin loosening and pain), functional outcomes (including range of motion, grip and pinch strengths) and radiological outcome were documented in intervals during follow-up. Forty eight patient, 22 males and 27 females with a mean age of 47.1 +/- 13.7 (19-80) years were enrolled. Local pain, infection and pin loosening were documented in 14.6, 16.7 and 2.1% of cases, respectively. Based on radiological reports, unacceptable palmar tilt, articular step, radial inclination and radial shortening were present in 6.3, 0, 2.1 and 6.3% of cases, respectively three months post-operation. The clinical outcomes according to Cooney's modification of the Green and O'Brien scheme were as excellent, good, fair and poor in 52.1, 31.3, 10.4 and 6.3% of cases, respectively. According to these results, closed reduction and percutaneous pinning of distal radius fractures is a rather successful method with minor complications.