Distal radius
Fifteen-Year Outcome of Displaced Intra-Articular Fractures of the Distal Radius

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Purpose

We previously reported the functional and radiographic outcomes of 21 young adults at an average of 7 years after open reduction and internal fixation of an intra-articular distal radius fracture (original study). The purpose of the current investigation was to evaluate the same cohort at an average of 15 years after surgery to evaluate the effect of additional time on both function and radiographic appearance.

Methods

We re-evaluated 16 of the original patients at an average of 15 years after surgery. Subjective assessment was performed with the Musculoskeletal Functional Assessment and the Hand Function Sort questionnaires. Objective assessment included a detailed physical examination and strength measurement. Standardized radiographs and computed tomography were used to assess wrist morphology, residual articular step and gap displacement, and the presence and degree of arthrosis.

Results

Subjectively patients continued to function at a high level at the last follow-up evaluation: the average Musculoskeletal Functional Assessment score was 10 and 14 of the 16 patients functioned at a high level according to the Hand Function Sort. Strength and range of motion remained essentially unchanged from the original report. Radiocarpal arthrosis was noted in 13 of the 16 wrists and joint space was reduced an additional 67% compared with the 7-year follow-up evaluation. Nonetheless there continued to be no correlation between the presence or degree of arthrosis and upper-extremity function.

Conclusions

Radiocarpal arthrosis after intra-articular distal radius fractures can be expected to worsen over time. Despite joint space narrowing and evidence of advanced arthrosis, however, patients maintained a high level of function at the long-term follow-up evaluation.

Type of study/level of evidence

Prognostic, Level II.

Section snippets

Materials and Methods

This investigation was a retrospective re-evaluation of 16 patients from an original cohort of 21 patients; the original results were published in 1997.1 Five of those patients were not included in this investigation: 4 could not be located (despite an extensive search including medical records, Internet, and a private investigator) and 1, who lived out of state, would not participate despite several requests. All patients had been treated at a single institution with open reduction and

Results

The average MFA score was 10 (SD, 9.2; range, 0–28). These data were compared with published normal data (mean, 9.3; SD, 8.9) and no difference was noted between the total scores or any of the subcategory scores (p = .66).2 The HFS showed that 9 of the 11 males and all of the females (n = 5) functioned at the heavy physical demand level with scores at the 80th percentile or higher compared with normal patients. These 14 patients showed broad functional capacity with no areas of limitation. The

Discussion

This investigation evaluated patients longitudinally at intermediate- and long-term follow-up periods and documented the progression of joint arthrosis by CT scan. By documenting the presence of arthrosis in the original investigation and confirming its advancement in the same patient cohort 8 years later we have confirmed and expanded on the known correlation between residual articular displacement and joint arthrosis.1, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 The arthrosis that is

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