Does acute edema after open reduction and internal fixation of distal radius fractures correlate with 3- and 12-month patient-reported outcomes? A retrospective series.

BACKGROUND

Edema following a distal radius fracture may affect clinical outcomes.

PURPOSE: This study aimed to determine if there is a relationship between edema before open reduction and internal fixation (ORIF) for distal radius fracture (DRF) and pain visual analog scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH), and Patient-Rated Wrist and Hand Evaluation (PRWHE) scores obtained at 3- and 12-month after ORIF.

STUDY

DESIGN

Retrospective cross-sectional series.

METHODS

Record review included adult patients who underwent ORIF within 2weeks of DRF and who had linear wrist and hand edema measurements taken before ORIF, 2days and 2weeks after ORIF, and instruction in elevation and finger exercises. Measurement of edema involved two methods---wrist circumference and figure-of-eight. Pain VAS, DASH, and PRWHE scores were obtained 3- and 12-month after ORIF. Reliability of edema measurements was done for 20 patients and analyzed using intraclass correlation coefficients. Time-dependent changes in edema were evaluated using paired t tests. The relationship between edema before ORIF and 3- and 12-month patient-reported outcomes (PROs) was analyzed using multivariable linear regression. Bivariate linear regression analysis was performed to evaluate the relationship between wrist circumference of before and after ORIF and 12-month PROs in quartiles of patients with the least and most wrist circumference before open reduction and internal fixation.

RESULTS

A total of 121 patient records were reviewed, with the patient mean age being 63.7±14.6years. Reliability of edema measures was excellent, with intraclass correlation coefficient for wrist circumference (0.892) and figure-of-eight (0.900). Both methods for measuring edema significantly increased between before ORIF and 2days after ORIF and significantly decreased 2weeks after ORIF. Multivariate analysis showed no statistically significant association between edema measured before ORIF and 3- and 12-month PROs. Bivariate regression in patients with the least and most wrist circumference before ORIF showed that regression coefficients for wrist circumference and 12-month PROs were decreased from before ORIF to 2-weeks after ORIF: pain VAS- 0.016 to -0.035, DASH- 0.480 to 0.374, and PRWHE 0.382 to 0.044.

CONCLUSIONS

Edema measured before ORIF in patients with DRF decreased within 2weeks to near-preoperative values. It is unknown whether this was due to elevation and movement instruction or natural recovery. Edema measurements before ORIF were not related to at 3- and 12-month pain VAS, DASH, and PRWHE scores.