2017 ISAKOS Biennial Congress Paper #91
The Study of Soft Tissue Status after Anatomical Fixation of Distal Radius Fracture
Margaret W. M. Fok, FRCSEd(Ortho), MBChB, Hong Kong HONG KONG
Christian Xinhua Fang, FRCSED(ortho), MBBS (Hong Kong), Hong Kong HONG KONG
Tak Wing Lau, FRCSED(ortho), MBBS (Hong Kong), Hong Kong HONG KONG
Boris Kwok Keung Fung, FRCSED(ortho), MBBS , Hong Kong HONG KONG
Frankie Ka Li Leung, FRCSED(ortho), MBBS (Hong Kong), Hong Kong HONG KONG
Queen Mary Hospital, The University of Hong Kong, Hong Kong, HONG KONG
FDA Status Cleared
Despite that a high proportion of soft tissue injury does not heal after anatomical fixation of distal radius fracture, patients may not experience associated signs and symptoms
Distal radius fractures were associated with a high incidence of trianglular fibrocartilage complex (TFCC) tear. This study aims to evaluate the status of TFCC after the union of distal radius fractures and to assess the functional outcome of patients with and without tears.
Patients who were elected for the removal of implants after union of distal radius fractures were recruited. Concomitant wrist arthroscopy was performed to assess the status of TFCC. Repair of TFCC was attempted for patients with symptomatic distal radioulnar joint (DRUJ) instability.
52 distal radius fractures were studied. There were 13 extra-articular distal radius fractures. 21 patients had ulnar wrist pain and 36 were noted to have DRUJ instability on examinations. The findings of wrist arthroscopies revealed 7 patients with intact TFCC. There were 32 complete tears and 23 incomplete tears showing signs of healing. 20 tears were repaired and 25 were not repaired, based on patients’ symptoms and whether the tear was deemed repairable.
At 6 months post-operatively, we found that while there was a trend in improvement in the range of movement of wrist, power and DASH score within the TFCC intact group, it did not reach statistically significance. For the patients with repaired TFCC, there was a statistically improvement in the wrist grip strength at 6 months 72% (pre) vs. 80% (post) p=0.039. While there was an improvement in the DASH score of 30 vs. 22 at 6 months, it was not statistically significant p=0.102. As for the patient with unrepaired TFCC, there was a statistically significant improvement in flexion, power and DASH at 6 months: 50 degrees vs 56 degrees p=0.006; 74% vs 84% p=0.002 and DASH 24 vs 11 p=0.003.
When we compare between the three groups, 1. patients with intact TFCC, 2. patients with TFCC repair and 3. patients with unrepaired TFCC, it was noted that there was statistically difference in terms of the pronation and supination prior to wrist arthroscopic procedure: 83 degrees vs. 80 degrees vs. 83 degrees p= 0.033 and 80 degrees vs 87 degrees vs 86 degrees p= 0.030, respectively. At 6 months post-operatively, again there was only significant statistically difference between the 3 groups in supination i.e. 78 degrees vs 87 degrees vs 86 degrees p= 0.024. There was no difference between the groups with their pre and 6 months post wrist arthroscopy DASH score.
A large majority of TFCC tears remained to be unhealed. However, their functional outcome may not differ from those with intact TFCC.