Advanced age and OA found as predictors of finger stiffness following distal radius fractures

BALTIMORE — Investigators have found that patients who are older and have prior osteoarthritis may be more likely to experience hand stiffness following treatment for distal radius fractures.

The type of treatment used, operative or nonoperative, did not have an effect on who would experience stiffness, according to Kenneth A. Egol, MD, in a presentation at the 2010 Annual Meeting of the Orthopaedic Trauma Association, here.

“Previous reports of stiffness following distal radius fractures generally were centered on wrist and forearm rotation, but little has been mentioned in terms of dexterity of the hand,” he said.

Goals

Egol said he and his and colleagues embarked on this study to determine the predictors of digital flexion following distal radius fractures and to evaluate the relationship between finger stiffness and outcome and work status following distal radial fracture treatment.

Kenneth A. Egol

The study is a retrospective review of 352 patients who sustained distal radius fractures and were treated either with a cast, external fixator or ORIF and had 1-year of follow-up.

“We obtained baseline, 3-, 6- and 12-month follow-up, we looked at patient demographics, DASH, and SF-36 functional outcomes,” he said. “We looked at their radiographs and measured grip strength and range of motion.”

All patients had a standardized postoperative physical therapy program.

Loss of flexion was defined as fingertip to palm distance greater than 1 cm for all fingers and based on this definition we found about a 20% distribution of stiffness in this group, he reported.

Less pain at 1 year

“Overall, we found that 16% of our group had experienced finger stiffness at some point during their recovery,” Egol said. “However, this stiffness did not correlate with the pain at any time point. In fact, at 1 year, the stiffer patients reported less pain than the nonstiff patients, although these differences were not significant.”

They found that age and the presence of osteoarthritis at presentation were the only factors that were associated with the development of hand and finger stiffness. In terms of hand function, they found that for all time periods, stiff patients had decreased wrist strength compared to the nonstiff patients, which was significant. For work function, Egol said that stiff patients were more likely to be on a leave of absence or disability at all time points and these differences were significant.

“We found no differences in the overall DASH scores, however when we factored out certain dexterity-based questions — the ability to open a jar, the ability to cut food, the ability to wash their back — the stiff patients had difficulty with these tasks at 3 and 6 months,” he said. However, at 1 year there were no differences.

“We also found that hand stiffness delayed patients’ return to work and they had less dexterity at 3 to 6 months with no differences seen at 1 year. Patients who were stiff had a grip strength difference at all time periods compared to those patients who were not stiff,” he said.

He concluded that for the subset of patients who experience hand stiffness following distal radius fracture, it may be important to counsel patients preoperatively about this possibility. “In addition, it is important to pay special attention to certain patients who present with osteoarthritis or advanced age and you can possibly target those patients with special rehab protocols or perhaps job training.”

Reference:
Lee SK, Paksima N, Lekic N, et al. Hand stiffness following distal radius fractures: Who gets it and is it a functional problem? Paper #30. Presented at the 2010 Annual Meeting of the Orthopaedic Trauma Association. Oct. 13-16, 2010. Baltimore.

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