نویسندگان

دانشگاه علوم پزشکی مازندران

چکیده

مقدمه: یکی از عوامل مؤثر در پیش‌بینی شکستگی انتهای رادیوس، اصلاحات آناتومیکی است. مطالعات مربوط به بازسازی آناتومیکی با پیامدهای عملکردی نتایج متعارضی داشته‌اند. این مطالعه با هدف بررسی رابطه بین شاخص‌های رادیوگرافی (آناتومیکی) پس از دررفتگی شکستگی‌های انتهای رادیوس با عملکرد و نتایج بالینی انجام شده است.
روش‌ها: در یک مطالعه کوهورت گذشته‌نگر، شاخص‌های رادیوگرافی شامل طول و شیب رادیوس، کجی (tilt) ولار، زاویة قطره‌اشکی (teardrop)، عمق حفرة مفصلی و فاصله قدامی خلفی (distant AP) مورد بررسی قرار گرفت. همچنین، قدرت نیشگون گرفتن و چنگ زدن (pinch & grip) مورد سنجش قرار گرفت و عملکرد به وسیله پرسشنامه کوئیک- دش (Quick DASH) ارزیابی شد.
یافته‌ها: نمرة درد با کوتاهی رادیال ارتباط معنی‌داری داشت (038/0=p)، اما مستقل از روش درمانی نبود. میزان رضایت بیماران در بیماران با عمق مفصل غیرطبیعی، جدا از سن و روش درمانی، به طور قابل توجهی پایین‌تر بود (004/0=p). نمرة کوئیک- دش به طور معنی‌داری با کوتاهی رادیال و عمق حفرة مفصلی، مستقل از روش درمانی و سن، ارتباط دارد (006/0=p). پین‌گذاری از طریق پوست به طور معنی‌داری با درد کمتر، معلولیت کمتر و رضایت بیشتر همراه بود (05/0>p).
نتیجه‌گیری: کوتاهی رادیال و عمق حفرة مفصلی با نتایج بالینی و عملکردی ارتباط دارد. در حالی که برخی مطالعات نشان می‌دهند که شاخص‌های رادیوگرافی در افراد مسن لزوماً با پیامدهای عملکردی ارتباط ندارند، در این مطالعه ارتباط شاخص‌های رادیولوژی با نتایج بالینی و عملکردی، مستقل از سن بود.
واژگان کلیدی: شکستگی انتهای رادیوس، شاخص رادیوگرافیک، نتایج بالینی، نتیجه عملکردی

کلیدواژه‌ها

عنوان مقاله [English]

The association between Radiological indices and functional outcomes in distal radius fracture

نویسندگان [English]

  • Mehran razavipour
  • salman ghaffari
  • masoud shayestehazar
  • abolfazl kazemi
  • Shayan Amjadi

چکیده [English]

Introduction: One of the factors affecting the prognosis of distal radius fracture is anatomical correction. Several studies conducted in connection with the reconstruction of anatomical and functional consequences, which have had conflicted results. This study has been designed and implemented aimed to investigate the relationship between radiological index (anatomical) after displaced distal radius fractures with function and clinical outcomes.
Methods: This is a retrospective cohort study to assess the association of radiological indices with clinical and functional outcomes of distal radius fractures. In this study, radiological indices, including the radius, volar tilt, tear drop angle, articular cavity depth and AP Distance were investigated. Pinch and grip strength were measured and Quick DASH questionnaire evaluated the performance.
Results: Pain score significantly correlated with radial shortening (P=0,038), but it was not independent of treatment method. Patients’ satisfaction rate was significantly lower in patients with abnormal articular depth, independent of age and treatment method (P=0.004). Quick-DASH score significantly correlated with radial shortening and articular cavity depth, independent of treatment method and age (P=0.006). Percutaneous pinning associated significantly with less pain, less disability and more satisfaction (P<0.05).
Conclusion: Radial shortening, articular cavity depth had a correlation with the clinical and functional outcomes. While Some studies suggested radiological indices in the elderly is not necessarily have a correlation with functional outcomes, in this study correlation of radiologic indices with clinical and functional outcome was independent of age.

کلیدواژه‌ها [English]

  • Distal Radius Fracture
  • radiological index
  • clinical outcomes
  • Functional Outcome
  1. Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br 1998;80(2):243–248.
  2. Owen RA, Melton LJ 3rd, Johnson KA, Ilstrup DM, Riggs BL. Incidence of Colles fracture in a North American community. Am J Public Health 1982;72(6):605–607.
  3. Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region.BMC Musculoskelet Disord 2007; 8:48.
  4. G Pienaar, C Anley, A Ikram, Restoration of teardrop angle (TDA) in distal radius fractures treated with volar locking plates. SA Orthopaedic Journal Spring 2013; 12(3): 32-34.
  5. DSo S . Guidelines Distal Radius Fractures, diagnosis and treatment. 2010. Anonymous http://www. nvpc.nl/uploads/stand/Richtlijn_Distale_radius_fracturen_voor_autorisatiefase_0110201075.pdf.
  6. Drobetz H, Kutscha-Lissberg E . Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop 2003;27(1):1–6.
  7. Nelson DL. How to classify distal radial fractures - a report. eRADIUS International Distal Radius Fracture Study Group. Basic knowledge, IFSSH Bone and Joint Committee2008. Available at http://www.eradius. com/IFSSH_Classification_D1.htm. Accessed october.
  8. Macdermid JC. The Patient-Rated Wrist Evaluation (PRWE) User Manual. School of Rehabilitation Science 2007: 6-7. Available at http://www.srs-mcmaster.ca/Portals/20/pdf/research_resources/PRWE_PRWHEUserManual_Dec2007.pdf. Accessed october 12 2014.
  9. J. MacKay, N. Montero, N. Paksima, K. A. Egol. Outcomes Following Operative Treatment of Open Fractures of The Distal Radius: A Case Control Study. The Iowa Orthopaedic Journal. 2013;33:12-18.
  10. Zalavaras, c. and M. Patzakis, Open fractures; evaluation and management. J Am Acad Orthop Surg. 11: p. 212-219.
  11. Schneiders W , Biewener A, Rammelt S, Rein S, Zwipp H, Amlang M. Distal radius fracture. Correlation between radiological and functional results. Unfallchirurg. 2006 Oct;109(10):83744. [Article in German].
  12. Tafoya Arreguín, GA, MartinezRuíz J, Rodríguez LM. Distal radius fracture: clinicoradiographic correlation after fixation with volar plate. Acta Ortop Mex. 2013 JanFeb;27(1):1721. [Article in Spanish].
  13. Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. Journal of orthopaedic trauma. 2009 Apr 1;23(4):237-42.
  14. Anzarut A, Johnson JA, Rowe BH, Lambert RG, Blitz S, Majumdar SR. Radiologic and patientreported functional outcomes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg Am. 2004 Nov;29(6):11217.
  15. Amadio PC, Berquist TH, Smith DK, Ilstrup DM,Cooney WP 3rd, Linscheid RL. Scaphoid malunion. J Hand Surg [Am]. 1989 Jul;14(4):679-87.
  16. Nijs S, Broos PLO. Fractures of the Distal Radius: a Contemporary Approach. Acta chir belg 2004;104:401-412.
  17. Altissimi M, Antenucci R, Fiacca C, et al. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res 1986;206:202-10.
  18. Aradhana T. R., Ramesh Krishna. K, Preetham N. Effect of radiological parameters on functional outcome in management of intra-articular fractures of distal end of radius – a retrospective study. Indian Journal of Orthopaedics Surgery 2015; 1(1): 43-49.
  19. Erhart S, Schmoelz W, Arora R, Lutz M. The biomechanical effects of a deepened articular cavity during dynamic motion of the wrist joint.Clin Biomech (Bristol, Avon). 2012 Jul;27(6):557-61.
  20. Erhart S, Schmoelz W, Lutz M. Clinical and biomechanical investigation of an increased articular cavity depth after distal radius fractures: effect on range of motion, osteoarthrosis and loading patterns. Arch Orthop Trauma Surg. 2013 Sep;133(9):1249-55.
  21. Leung F, Eylul D, Chow SP. Conservative treatment of intra-articular fractures of the distal radius - factors affecting functional outcome. Hand Surg 2000;5(2):145-153.
  22. Batra S, Gupta A. The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures. Injury 2002;33(6):499–502.
  23. Claudio R M, Danilo C D, Rafael M M, Roberto D T. Surgical treatment of distal radius fractures with a volar locked plate: correlation of clinical and radiographic results. Rev Bras Ortop. 2011;46(5) :505-13.
  24. Missakian ML, Cooney WP, Amadio PC, et al. Open reduction and internal fixationfor distal radius fractures. J Hand Surg Am 1992; 17(4): 745-755.
  25. Mark EB , John DD, Donald DA, et al.Displaced intra-articular fractures of the distal radius: The effect of fracture displacement on contract stresses in a cadaver model. J Hand Surg Am 1996; 21(2):183-188.
  26. Rodríguez-Merchan, Carlos E. Management of comminuted fractures of the distal radius in the adult: conservative or surgical? Clin Orthop Relat Res 1998; 353:53-62.
  27. Jaremko JL, Lambert RG, Rowe BH, Johnson JA, Majumdar SR. Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment?. Clinical radiology. 2007 Jan 1;62(1):65-72.
  28. Finsen V, Rod O, K Rød K, et al. The relationship between displacement and clinical outcome after distal radius (Colles') fracture. J Hand Surg Eur. 2013;38: 116.