Quantification of Wrist Functional Variables, in Female Patients Over 60 Years of Age With a Distal Radius Fracture, at Weeks 6 and 12 Following Surgical Management With a Locked Volar Plate and After the Use of a Standardized Rehabilitation Program

Abstract

Purpose: A distal radius fracture is one of the most common fractures in females over 60 years of age. In the clinical setting, a delay in the correct return to daily living and work activities has been observed. Furthermore, there is a lack of scientific data in regard to functional deficits during the first 3 months following surgical management. For these reasons, there is interest to quantify wrist function in female patients, after surgical treatment with a locked volar plate. To quantify wrist function, a standardized rehabilitation program was implemented. Wrist function was measured by the Patient-Rated Wrist Evaluation (PRWE) questionnaire, wrist/forearm range of motion (ROM), and grip/pinch strength at weeks 6 and 12 following surgery. Methods: The study was approved by the ethics committee according to the Helsinki declaration. It had an observational, descriptive, nonexperimental and longitudinal design. Thirty-six female patients over 60 years, with an unstable distal radius fracture (type B or C of the Arbeitsgemeinschaft für Osteosynthesefragen [AO] classification), treated surgically with a locked volar plate, were evaluated prospectively from September 2013 to October 2014. All patients were right-handed. Seventeen had injured their right hand and 19 their left. The PRWE questionnaire and measurements of wrist/forearm ROM and grip/pinch strength were completed at weeks 6 and 12 following surgical intervention. Statistical analyses were performed by using a Student paired t test, to evaluate outcomes at weeks 6 and 12 of follow-up. Results: Significant differences were found with PRWE questionnaire, wrist/forearm ROM, and grip/pinch strength measurements at week 12 versus week 6. Furthermore, only 8% of the patients (3/36) at week 12 versus 50% (18/36) at week 6 had a score above 50 on the PRWE questionnaire. The injured hand was also compared to the noninjured hand at week 12, for wrist/forearm ROM and grip/pinch strength. With regards to the ROM, there were significant differences for flexion, extension, pronation, and ulnar deviation. Last, when grip/pinch strength was compared in the injured versus noninjured hand at week 12, results showed that 72% of the patients (26/36) had a grip strength above 50% of their noninjured hand. For lateral and tridigital pinch strength, 36 of 36 and 33 of 36, respectively, had above 50% strength of their noninjured hand. Furthermore, 44% (16/36) and 42% (15/36) had lateral and tridigital grip strength above 80% of their noninjured hand. Conclusion: The standardized rehabilitation program utilized in this study is safe and reliable to be used for patients with distal radius fractures managed with a locked volar plate. There was a considerable improvement in wrist function after the standardized rehabilitation program was completed. The significant decrease in pain and disability, together with the improvements in ROM and grip/pinch strength, allowed the correct return to daily living and also work activities, at 3 months after the surgical intervention.