Introduction
Clinician reported outcome
Patient reported outcome
Purpose of the study
Methods
Literature search
Radius fractures | (“Radius Fractures”[Mesh] OR Radius Fracture*[tiab] OR (“Radius”[Mesh] AND “Fractures, Bone”[Mesh])) |
---|---|
Post-traumatic or osteoarthritis | (post traumatic*[tiab] OR posttraumatic*[tiab] OR arthros*[tiab] OR arthrit*[tiab] OR “Joint Diseases”[Mesh] OR osteoarthrit*[tiab]) |
Functional outcome or patient reported outcome or health status | (“Questionnaires”[Mesh] OR Questionnaire*[tiab] OR short form 36[tiab] OR dash[tiab] OR sf 36[tiab] OR (arm[tiab] AND shoulder[tiab] AND hand[tiab]) OR prwe[tiab] OR patient rated wrist evaluation[tiab] OR mhq[tiab] OR (michigan[tiab] AND hand[tiab] AND outcome*[tiab]) OR “Patient Satisfaction”[Mesh] OR “Patient Satisfaction”[tiab] OR “Pain”[Mesh] OR “Pain”[tiab] OR “Disability Evaluation”[Mesh] OR disabilit*[tiab] OR “Quality of Life”[Mesh] OR qol[tiab] OR “Quality of Life”[tiab] OR life qualit*[tiab] OR range of motion[tiab] OR “Range of Motion, Articular”[Mesh] OR “Recovery of function”[Mesh] OR convalescen*[tiab] OR grip strength[tiab] OR health status[tiab] OR “health status”[Mesh] OR “Health Status Indicators”[Mesh]) |
Quality assessment
Category | Item # | Newcastle–Ottawa Quality Assesment Scale—Cohort Studies | Points |
---|---|---|---|
Selection | 1 | Representativeness of the exposed cohort | |
a. Truly representative of the average non-osteoporotic patient with a distal radius fracture in the community | 1 | ||
b. Somewhat representative of the average non-osteoporotic patient with a distal radius fracture in the community | 1 | ||
c. Selected group of users, e.g. nurses or volunteers | 0 | ||
d. No description of the derivation of the cohort | 0 | ||
2 | Selection of the non-exposed cohort | ||
a. Drawn from the same community as the exposed cohort | 1 | ||
b. Drawn from a different source | 0 | ||
c. No description of the derivation of the non-exposed cohort | 0 | ||
3 | Ascertainment of exposure | ||
a. Secure record (e.g. surgical records) | 1 | ||
b. Structured interview | 1 | ||
c. Written self-report | 0 | ||
d. No description | 0 | ||
4 | Demonstration that outcome of interest was not present at start of study | ||
a. Yes | 1 | ||
b. No | 0 | ||
Comparability | 5 | Comparability of cohorts on the basis of the design or analysis | |
a. Study controls for posttraumatic arthritis following a distal radius fracture | 1 | ||
b. Study controls for any additional factor (this criteria could be modified to indicate control for a second important factor) | 1 | ||
Outcome | 6 | Assessment of outcome | |
a. Independent blind assessment | 1 | ||
b. Record linkage | 1 | ||
c. Self-report | 0 | ||
d. No description | 0 | ||
7 | Was follow-up long enough for outcomes to occur | ||
a. Yes (adequate follow-up for posttraumatic arthritis to occur: at least 2 years) | 1 | ||
b. No | 0 | ||
8 | Adequacy of follow-up of cohorts | ||
a. Complete follow-up—all subjects for at least 12 months | 1 | ||
b. Subjects lost to follow-up unlikely to introduce bias—small number lost <10% | 1 | ||
c. Follow-up rate >10% and no description of those lost | 0 | ||
d. No statement | 1 | ||
Total | 9 points |
Posttraumatic arthritis assessment
Clinician reported outcome
Patient reported outcome
Data analysis
Results
Study selection
Study and patient characteristics
All studies
Non open source | |||||||||||
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References | NOS | Study type | Eligble N/N
| Mean age (years) | Follow-up (months) | PA | ROM | Grip strength | PRO; mean | Associations with PA | Predictors for PA |
Bolmers et al. [18] | 5 MQ | PS | 47 | 39 | 240 | Not described | + | + | DASH; B#; 14 C#; 15 | ROM: NS Grip strength: NS PRO: NS | – |
Foldhazy et al. [36] | 7 HQ | PS | 37/66 | 45 | 108–156 | gr I: 8/66 | + | + | ROM: NS Grip strength: NS | – | |
Forward et al. [11] | 5 MQ | RS | 106 | 25 | 456 | gr 0: 50 gr I: 31 gr II: 21 gr III: 4 | − (% uninjured wrist) | + | DASH; EA# 9 IA# 13 | Grip strength: no conclusion VAS: NS DASH: no conclusion | Radial length (OR 1.21, 95% CI 1.02–1.45) Dorsal angulation (OR 1.07, 95% CI 1.03–1.1) Radial inclination: NS Intra-articular fracture (OR 3.23, 95% CI 1.43–7.14) |
Goldfarb et al. [34] | 7 HQ | RS | 16 | 32 | 180 | gr 0: 0 gr I: 6 gr II: 7 gr III: 2 | + | + | ROM: poorer F (p < 0.02) Grip strength: NS PRO: NS | ||
Kopylov et al. [13] | 4 LQ | RS | 76 | 31 | 384 (32 yrs) | 33% PA RC 25% PA DRUJ | + | + | ROM: no conclusion Grip strength: no conclusion PA RC ‘more complaints’ than PA DRUJ, no correlation reported | Ulnar variance (2.7 mm with PA vs. 0.9 mm without PA, p < 0.01) Dorsal angulation: NS Radial inclination: NS Gender: NS | |
Lindau et al. [14] | 5 MQ | PS | 76 | 41 | 26 | gr 1: 9 | + | + | No conclusions | Dorsal angulation: NS Radial shortening: NS Radial inclination: NS Ulnar variance: NS Arthroscopically verified subchondral hematoma | |
Lutz et al. [15] | 7 HQ | RS | 81 | 38 | 108 | gr 0: 2 gr I: 45 gr II: 34 | + | + | DASH; 7.5 | ROM: F/E: sign lower in gr II vs. gr I PA, (p = 0.03) Grip strength: NS VAS: NS DASH: NS | Articular (6/7 patients with stepn >1 mm developed severe PA) Articular cavity depth (4.1 mm gr I PA vs. 5.8 mm gr II PA, p < 0.05) AP distance (20.3 mm gr I PA vs.21.7 mm gr II PA, p < 0.05) Palmar tilt: NS Radial shortening: NS Radial inclination: NS |
Rogachefsky et al. [38] | 6 MQ | RS | 17 | 43 | 30 | gr 0: 3 gr I: 10 gr II: 3 gr III: 1 | + | + | No conclusions | – | |
Sharma et al. [17] | 8 HQ | PS | 64 | OP 48 NO 52 | 24 | NO gr I: 16 OP gr I: 5 | + | + | DASH; NO 14 OP 5 | ROM: NS Grip strength: NS PRO: no conclusion | Less PA in surgically treated patients NO 16 OP 5 |
Open source | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
References | NOS | Study type | Eligble N/N
| Mean age (years) | Follow-up (months) | PA | ROM | Grip strength | PRO; mean | Associations with PA | Predictors for PA |
Beyermann [37] | 6 MQ | RS, POS (no PA) | 10/19 | 53 | 32.5 | All <gr II | + | + | DASH; 11.5 | No conclusions | – |
Catalano et al. [10] | 5 MQ | RS, POS | 21 | 30 | 86 | gr 0: 5 gr I: 10 gr II: 6 | + | + | ROM: supination (rho = −0.476, p = 0.029) Grip strength (r = 0.463, p = 0.034) PRO: NS | Step (r = 0.74, p < 0.001) Gap (r = 0.70, p < 0.001) | |
Doi et al. [33] | 7 HQ | PS, OS | 33/82 | 52 | 31 | gr 0: 16 gr I: 10 gr II: 6 gr III: 1 | + | + | ROM: F (r = −0.350, p = 0.046) Grip strength: no conclusion | Incongruency (p < 0.001) Arthroscopically assisted reduction less PA (p = 0.014) | |
Espen [19] | 5 MQ | RS, OS | 11/20 | 53 | 38 | gr 0:3 >gr 0:8 | + | + | DASH; 20.5 | ROM: NS Grip strength: NS PRO: NS | – |
Fernandez et al. [12] | 8 HQ | RS, OS | 31/50 | 49.6 | 28.8 | 1/31 | – | – | SF-36; PC: 46.58 MC: 53.06 | PRO: With PA significant lower PC score than without PA (27.9 vs. 48.2, p < 0.001) | Incongruency (p < 0.005) |
Fitoussi et al. [35] | 4 LQ | PS, OS | 31/34 | 42 | 24 | gr 0: 23 gr I: 2 gr II: 4 gr III: 2 | + | + | ROM: F (r = −0.429, p = 0.016) Supination (r = −0.423, p = 0.018) Grip strength: no conclusion | Incongruency >2 mm (p < 0.05) | |
Jupiter and Lipton [29] | 5 MQ | RS, OS | 10/13 | 35 | 30 | gr 0: 9 >gr II: 1 | + | + | No conclusions | – | |
Ring et al. [16] | 7 HQ | PS, OS | 18/25 | 46 | 26 | gr 0: 13 gr I: 4 gr II: 1 | + | + | ROM: NS Grip strength: NS | – | |
Strange-Vognsen [39] | 4 LQ | RS, POS | 42 | 29 | 187 | gr 0: 15 gr I: 11 gr II: 9 | – | ± (only reduced y/n) | No conclusions | Residual deformity (r = 0.34, p < 0.05) Step (r = 0.34, p < 0.05) Dorsal angulation: NS Radial inclination: NS | |
Tyllianakis et al. [30] | 5 MQ | PS, POS | 6/21 | 53.5 | 13 | gr 0: 3 gr I: 2 gr II: 1 | + | + | No conclusions | – | |
Total | 7 HQ 9 MQ 4 LQ | 7 OS 3 partially OS | 733 (OS 213) | 37 yrs (range 25–54) | range (13-456) | gr 0: 142 > gr 0: 343 | 15 | 17 | 9 |
Open source
Characteristics | PA (N = 79) | No PA (N = 117) | Total population (N = 213) | Significance | |
---|---|---|---|---|---|
N/median (IQR) | N/median (IQR) | N/median (IQR) | % | ||
Age (years) | |||||
N
| 79 | 117 | 213 | NS | |
Median | 36 years (27–44) | 37 years (27–44) | 37 yrs (27–44) | ||
Gender | |||||
Male | 64 | 92 | 169 | 79 | NS |
Female | 15 | 24 | 44 | 21 | |
Follow-up (months) | |||||
N
| 193 |
p = 0.026 | |||
Median | 46 months (24–100) | 28 months (24–37) | 31 months (24–73) | ||
Trauma energy | |||||
Low energy | 7 | 4 | 15 | 21 | NS |
High energy | 30 | 25 | 58 | 79 | |
AO/OTA fracture classification | |||||
A | 3 | 11 | 11 | 6.4 | NS |
B | 56 | 10 | 13 | 7.6 | |
C | 59 | 81 | 147 | 86 | |
Treatment | |||||
Non-operative | 18 | 14 | 38 | 18 |
p = 0.047 |
Surgery | 61 | 102 | 174 | 82 | |
Articular incongruence at follow-up (step and/or gap) | |||||
No | 8 | 58 | 66 | 48% |
p < 0.001 |
Yes | 51 | 20 | 71 | 52% | |
Step (mm) median | 1.0 mm (1.0–2.0) | 0.0 mm (0.0–1.0) | 1.0 mm (0.0–1.7) |
p < 0.001 | |
No | 9 | 25 | 34 | 39 | |
Yes | 44 | 10 | 54 | 51 | |
Gap (mm) median | 0.0 mm (0.0–1.0) | 0.0 mm (0.0–0.0) | 0.0 mm (0.0–1.0) |
p = 0.017 | |
No | 20 | 19 | 39 | ||
Yes | 13 | 2 | 15 | ||
Grading PA according to Knirk and Jupiter | |||||
Gr 0 | 84 | 84 | 55 | ||
Gr I | 39 | 39 | 25 | ||
Gr II | 28 | 28 | 18 | ||
Gr III | 3 | 3 | 2 |
Association between PA and CRO: range of motion
All studies
Open source
Range of motion | PA | No PA | Significance | |||||
---|---|---|---|---|---|---|---|---|
N
| Mean (°) | SD |
N
| Mean (°) | SD |
N
| ||
Flexion | 124 | 52 | 18 | 55 | 52 | 16 | 69 | NS |
Extension | 124 | 53 | 13 | 55 | 54 | 11 | 69 | NS |
Arc motion F/E | 124 | 105 | 26 | 55 | 107 | 23 | 69 | NS |
Ulnar deviation | 104 | 23 | 9 | 49 | 25 | 8 | 55 | NS |
Radial deviation | 104 | 14 | 6 | 49 | 17 | 6 | 55 |
p = 0.037 |
Arc motion UD/RD | 104 | 37 | 12 | 49 | 42 | 11 | 55 |
p = 0.063 |
Pronation | 124 | 76 | 14 | 55 | 75 | 12 | 69 | NS |
Supination | 124 | 76 | 15 | 55 | 81 | 19 | 69 | NS |
Grip strength | PA | No PA | Significance | |||||
---|---|---|---|---|---|---|---|---|
N
| Mean (%) | SD | Mean (%) | SD |
N
| |||
% Grip strength | 124 | 79 | 18 | 55 | 79 | 15 | 69 | NS |
Association between PA and CRO: grip strength
All studies
Association between PA and PROs
Predictors of PA
All studies
Open source
Radiological measurement |
N
| PA | No PA | Significance | ||||
---|---|---|---|---|---|---|---|---|
Mean | SD |
N
| Mean | SD |
N
| |||
Dorsal angulation (°) | ||||||||
Postreduction | 31 | 1 | 7.6 | 8 | −3.3 | 9.4 | 23 | NS |
Follow-up | 149 | −1.3 | 10.2 | 58 | −2.7 | 9.3 | 91 | NS |
Radial length (mm) | ||||||||
Postreduction | 33 | 10.1 | 5.2 | 8 | 9.9 | 3.7 | 23 | NS |
Follow-up | 81 | 10.6 | 3.9 | 25 | 10.8 | 3.6 | 56 | NS |
Ulnar variance (mm) | ||||||||
Postreduction | 27 | 1.4 | 2.1 | 7 | −0.2 | 2.0 | 20 | NS |
Follow-up | 98 | 1.0 | 2.3 | 45 | 0.9 | 2.3 | 53 | NS |
Radial inclination (°) | ||||||||
Postreduction | 31 | 21.3 | 8.9 | 8 | 19.7 | 5.7 | 23 | NS |
Follow-up | 148 | 21.5 | 5.1 | 57 | 21.2 | 4.7 | 91 | NS |