Pathomechanics of the wrist following fractures of the distal radius

Abstract

IntroductionThe wrist positions the hand in space and allows load transmission from the hand to the forearm. This research study aimed to explain the biomechanical changes that occur at the wrist following a fracture of the distal radius and to explore the effect of this fracture on wrist and hand range of motion and muscle strength. It was hypothesised that a fracture of the distal radius interferes with the biomechanical integrity of the wrist limiting the available wrist and hand range of motion. This in turn affects hand muscle strength.MethodsThis prospective research study adopted a quantitative quasi-experimental time-series design where 109 patients followed an occupational therapy programme for 12 weeks. Measurements of forearm, wrist and hand range of motion and hand muscle strength were taken on the initial assessment, and on the 6th and 12th weeks of intervention. A standard evaluation procedure was followed to ensure reliability of the results. Data were analysed using SPSS (PASW version 18).ResultsForearm and wrist range of motion and muscle strength were significantly impaired. Hand range of motion was also affected even though the hand itself was not directly involved in the injury. Improvements in range of motion were accompanied by an increase in hand muscle strength. Patients with intra-articular fractures experienced greater limitations compared to their counterparts.ConclusionsThese results supported the initial hypothesis. Clinically, this highlights the need for orthopaedic management and rehabilitation to be based on a sound knowledge of the biomechanical interaction of the different structures involved.