Long-term results of broken forearm bones include limited impairment, disability

Arjan G. J. Bot

BOSTON — Twenty-one years after fracturing both bones of the forearm, skeletally mature and immature patients both display limited impairment and disability after nonoperative and operative treatment respectively, according to a study presented here.

The findings were presented by Arjan G. J. Bot at the 2010 Annual Meeting of the American Society for Surgery of the Hand.

“We know from literature that in short- to medium-term follow-up, grip strength is 75% to 85% preserved and rotation 90%,” Bot said. “The aim of our study was to test function at long-term follow-up and assess perceived disability.”

21-year follow-up

Bot's team evaluated 71 patients at an average of 21 years after initial injury. The majority of the 35 skeletally immature patients, Bot said, was treated conservatively with closed reduction and cast immobilization, while the majority of the 35 skeletally mature patients was treated with plate and screw fixation.

Evaluation included radiographs and measurements of range of motion and grip strength, with questionnaires being used to measure arm-specific disability, misinterpretation or over interpretation of pain, and depression.

Better motion, comparable disability

Bot said his group found that patients who were skeletally immature at the time of their injury had better motion, but comparable disability.

“We saw that there were statistically significant differences in function between the immature and mature patients,” he said.

Fracture classifications in the study were as follows:

AO/OTA-type-22-A3 in 46 patients;
22-type B3 in 18 patients, and
22-type C in 7 patients.

Rotation and wrist flexion/extension, Bot reported, were 91% of the uninjured side, with grip strength of 94%. Bot also reported “small, but significant” differences in rotation and wrist flexion/extension — but not disability — between skeletally mature and immature patients.

“In the whole cohort, there was a limited functional impairment and pain and pain catastrophizing correlated with disability,” Bot concluded.

Reference:

Bot AGJ, Doornberg JN, Lindenhovius ALC, et al. Long-term outcomes of fractures of both bones of the forearm. Paper 7. Presented at the 2010 Annual Meeting of the American Society for Surgery of the Hand. Oct. 7-9, 2010. Boston, Mass.

This is a long-term follow-up study with a 65% follow-up, which is pretty outstanding after 20 years — especially in that patient population.

There were some clinical differences, but I think they were so small that even though they were statistically significant they were probably not meaningful to us. Disability was correlated with pain and pain catastrophizing, and that does not surprise me either.

I want to congratulate the authors on putting a large amount of work and energy into finding these patients after 20 years. It is our general perception that these fractures do quite well, but it is nice to see this on long-term follow-up.

– Thomas W. Wright, MD
American Society for Surgery of the Hand Moderator

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