fore-arm instability wrist fracture
Conditions
Interventions
None listed
Sponsors
Leids Universitair Medisch Centrum
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: * radiographically proven distal radius fracture in the period 2008-2010, conservatively treated in the LUMC * age > 18 years * distal radius consolidation, as confirmed on radiographs.
Exclusion criteria
Exclusion criteria: * unwilling or unable to provide informed consent to participate in this study
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| DRUJ instability confirmed by physical examination (stress test or clunck test positive) and CT-scan. Static clinical DRUJ instability will be diagnosed with the stress test. The test is positive if there is more anterolateral movement of the ulna, relative to the stabilized radius than compared to uninjured wrist. Dynamic clinical DRUJ instability will be diagnosed by the clunck test. During passive rotation of the wrist the ulna is compressed to the radius. This test is positive if a clunck is palpable for the subject. DRUJ instability will be evaluated on the CT-scan of both wrist in maximal pro- and supination as described by the subluxation ratio [46]. Two lines perpendicular to a line connecting the volar and dorsal margins of the sigmoid notch are drawn from the volar and dorsal margins of the sigmoid notch. The ratio of the length of CD to that of AB is calculated. (Fig. 1). Normal values are 0.2, 0.01 and -0,13 in maximal pronation, neutral and maximal supination respectively. | — |
Secondary
| Measure | Time frame |
|---|---|
| o Wrist function Physical examination will include determination of restricted or blocked pronosupination, ulnar and radial deviation, dorsal and palmar flexion using a goniometer, and grip and pinch strength using a JAMAR® Hydraulic Hand Dynamometer and JAMAR® Hydraulic Pinch Gauge. For each patient maximal range of motion in any direction will be tested three times and measured by a goniometer. Both maximal grip and pinch strength, with the elbow in 90dgrs of flexion and shoulder in neutral position will be measured three times. The average of the three measurements will determine function. Loss of function is defined as 10% or more decrease in arc of motion (pro- and supination, ulnar-radial deviation and palmar-dorsal flexion) compared to the uninjured side. o Malunion Malunion is defined as the difference in radial length, radial inclination and volar tilt as confirmed on the CT, comparing the injured with the uninjured wrist. More than 10% difference is considered malunion. o Pain Pain is indicated on a 100-point visual analogue score. Patients will be asked to indicate their pain four times for each wrist; first time without loadbearing, the second time imagining bearing a 10kg weight. Both in rest and movement. o Subjective health assessment Subjective assessments of quality of life and wrist function will be obtained using the Mayo modified wrist score [5], Gartland and Werley score [15], Disabilities of the Arm, Shoulder and Hand (DASH) [23] and Short Form-36 (SF-36) [25]. Patients can fill them out at home or during their visit. o Associated unknown traumatic changes Associated unknown traumatic changes (additional ligamenteous or osseous changes) on CT-scan are defined as traumatic changes not mentioned on the existing investigations, nor intentionally treated during follow-up. o Complications Complications are defined as adverse medical responses after the treatment of the distal radius fracture during follow-up. o Radio | — |
Countries
Netherlands
Outcome results
None listed