Digital edema predicted postoperative recovery for distal radius fracture

NATIONAL HARBOR, Md. — The presence of digital edema in patients treated for unstable distal radius fractures with locked volar plating showed the ability to predict early functional plateau, according to a speaker here.

“Anecdotal evidence indicates that some patients will achieve [functional] plateau earlier than 1 year and some will progress later, and we do not know why,” Michael Maceroli, MD, said at the Orthopaedic Trauma Association Annual Meeting. “No current research demonstrates predictors for early functional recovery following distal radius fracture, and we wanted to identify physical exam findings to predict early function.”

Researchers evaluated 58 patients who had unstable distal radius fractures treated with locked volar plating. Of these patients, 23 patients were followed up for at least 1 year. The primary outcome measure for the study was Patient Reported Wrist Evaluation (PRWE) score, and secondary outcomes measures were the DASH and Pain Catastrophizing Scale (PCS) scores. Functional plateau was identified as a difference in PRWE scores of less than or equal to 10 points. Digital edema was measured by circumference at the proximal interphalangeal joint level index through the small finger. Follow-up visits were recorded at 1 week, 4 weeks to 6 weeks, 12 weeks and 6 months.

Mean PRWE score at 1-year follow-up was 12.6. The DASH score was 15 and the PCS score was 2.3 for patients who reached the functional plateau before the 1-year follow-up (69%).

“Patients who achieved plateau early did so with better functional scores at 1 year. For those reasons, we recommend that clinicians measure digital edema at routine postoperative visits to help dictate to patients their potential clinical course,” Maceroli said.

While the difference in digital edema equal or less than 0.5 mm showed 75% sensitivity and 57% specificity as a test to predict early functional plateau, distance between fingernail to palm did not demonstrate a correlation for a predictive test, Maceroli said.

“We can take this in future directions. We know that the edema is associated with rapidity of recovery, but we do not know what caused the edema at the 1-week visit,” he said. – by Nhu Te

Reference:

Maceroli M. Paper #62. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 5-8, 2016; National Harbor, Md.

Disclosure: Maceroli reports no relevant financial disclosures.