The effect of malunion of distal radial fractures on hand function

Introduction: Fractures of the distal radius were considered in the past to heal without permanent disability. While many authors have demonstrated that a congruent articular surface is crucial in preventing future pain and post-traumatic arthrosis, the importance of other reduction parameters, such as radial shortening and articular surface tilt, has not gained universal consensus, and their contribution to future hand function remains unclear. In this work, we have evaluated the effects of the importance of angular deformity and shortening of distal radius post-reduction on some parameters of hand function. Method: Between 1994 and 1996, 24 consecutive patients who had sustained different types of fracture of the distal radius were reviewed retrospectively. All of the patients had follow-up at least one year after their fracture. All fractures were treated by closed reduction and plaster of Paris fixation for a duration of six weeks. All patients were evaluated by two separate examiners for pain, range of motion, strength, radial length and dorsal tilt. Result: We demonstrate that non-anatomic reduction can affect certain outcome parameters more significantly, while others remain unchanged. The range of motion in extension remained unaffected in all of our patients, whereas radial and ulnar deviation were decreased even when an anatomical reduction was achieved. Range of motion in flexion was significantly reduced in all patients who did not have an anatomical reduction. Pinch was highly affected by non-anatomical reduction, while grip, though numerically reduced, showed no significant change. Pain did not correlate with reduction quality, and we could not demonstrate any specific parameter predictive of continued wrist pain following fracture healing.