Management of Distal Radius Fractures: Comparison of Three Methods

Functional Outcomes in the Distal End of Radius Fracture: A Prospective Study in a Tertiary Care Center

OBJECTIVES

The objectives of this study are to determine the functional outcomes and compare them between conservative and surgical management in patients managed for closed-type intra-articular distal end of radius fractures.

METHODS

A prospective observational study was done on 150 patients who underwent treatment for closed-type intra-articular distal end of radius fractures. As per Frykman Classification, they were type III. Patients were either managed conservatively, i.e. 100 patients out of 150 and surgical management was done in 50 cases. For surgical management, implants used were K-wires, Schanz pins, and Ellis Plate. The functional outcomes were noted in terms of pain and range of motion, in the follow up of six months. Union was noted clinically and radiologically.

RESULTS

The mean age of the study patients was 42.32 ± 15.77 years. Out of 150 patients, there were 100 (66.67%) male patients. Compared to conservative management, surgical management had significantly lesser time of union (12 vs. 20 weeks, P<0.0001); significantly more excellent results (44% vs. 30%), more good results (32% vs. 15%) (P=0.003); comparable pain score (P=0.236); and comparable functional score (P=0.661). Regarding radiological outcomes, surgical management had significantly more volar tilt (9.6±2.5° vs. 8±5°, P=0.035); lesser Ulnar variance (3±2 vs. 4±2 mm, P=0.004), lesser grip strength <50% (26% vs. 65%, P<0.0001); comparable radial inclination (21±4° vs. 20±5°, P=0.661); and comparable radial height (11±3 vs. 10±5 mm, P=0.195) Conclusion: To conclude, surgery for distal radius fractures promotes faster healing, lesser pain, lesser malunion, and better functional outcomes. However, it is not without potential risks. Non-surgical treatment is still a suitable option, for patients with contraindications to surgery or having lower need for functional improvement.

Frykman VIII Fracture Secondary to Falling Onto an Outstretched Hand (FOOSH)

This is the case of a 41-year-old woman who presented with pain in the wrist after a fall from her bicycle, after which she tried to block her fall by outstretching her hand. She sustained a Frykman VIII fracture, with a fracture of the distal radius and ulnar styloid. Her labs were unremarkable, and she had no previous medical history. Her case was an example of a classic fracture due to FOOSH (falling onto an outstretched hand) which can easily be avoided by learning how to break falls properly. The patient's symptoms, diagnosis, treatment, and ways to avoid this injury are presented.

Gamification for Distal Radius Fracture Rehabilitation: A Randomized Controlled Pilot Study

Introduction

Gamification is a novel interventional approach to functional recovery and rehabilitation. A significant impact has been observed with the application of gamification on non-traumatic conditions and chronic neurological and musculoskeletal illnesses; however, the implication of gamification on the functional recovery of patients with distal radius fractures (DRF) is yet to be explored. 

Methodology

This pilot study included 20 post-DRF patients aged 18-65 years with unilateral DRF, managed with closed reduction and K-wire internal fixation. The patients were assigned to group A (gamification) and group B (conventional rehabilitation) in a 1:1 ratio. Group A patients played Racket: NX game, Until you fall game, and Holofit game on Oculus Quest head-mounted display (HMD) (Oculus, USA), while group B patients received a conventional rehabilitation program. Both groups underwent a rehabilitation program for 60 min/day, five days a week, for four weeks. The visual analogue scale (VAS), universal goniometer, Jamar dynamometer, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire were used as outcome measures at baseline, at the end of the second week, and at the end of treatment.

Results

There were significant improvements in pain, range of motion (ROM), grip strength, and functional independence in both groups. However, improvements in hand function and functional independence were significantly greater in the gamification group than in the conventional physiotherapy rehabilitation group.

Conclusion

The study concluded that gamification appears to have a significant impact on post-DRF rehabilitation in terms of pain, ROM, grip strength, and functional independence. Further research with larger sample sizes is required to confirm the preliminary findings.