Determining the Borderline Anatomical Parameters for Better Functional Outcome of Colles Fracture: A Prospective Study / Determinação dos parâmetros anatômicos limítrofes para melhor desfecho funcional da fratura de Colles: Um estudo prospectivo

Abstract Objective The treatment of Colles fracture can deform the wrist. Some studies claim the resulting deformity rarely hinders daily activities, whereas others report the opposite; thus, anatomical reduction is desirable. Our objective was to analyze the anatomical and functional results of Colles fracture to find out the values of individual parameters corresponding to the best functional outcome. Methods The present prospective study included 70 elderly patients with Colles fracture. All patients were managed conservatively. The anatomical parameters were evaluated by measuring dorsal angulation, radial inclination, and radial height, and they were assessed as per Stewart et al. The functional result was assessed by the Mayo wrist score. The results were analyzed using the chi-squared test of association, and a p-value < 0.001 was considered statistically significant and to examine strengths of associations; we computed odds ratios (ORs) with 95% confidence intervals (CI). Results Excellent and good results were obtained in 68.5% of the cases anatomically and 78.5% functionally, which was statistically significant (p= 0.0009). Out of the three anatomical parameter dorsal angulation < 10° and loss of radial inclination < 9° showed statistically significant association with functional results (p= 0.0006), but loss of radial height < 6 mm did not (p= 0.0568), which became significant when loss of radial height was kept < 4 mm (p= 0.00062). Conclusion Fractures with anatomical reduction have better functional results. The acceptable borderline anatomical parameters for obtaining excellent or good functional results are dorsal angulation < 10°, loss of radial inclination < 9°, and loss of radial height < 4 mm.

Resumo Objetivo O tratamento da fratura de Colles pode deformar o pulso. Alguns estudos afirmam que essa deformidade raramente dificulta as atividades diárias, enquanto outros relatam o contrário; assim, a redução anatômica é desejável. Nosso objetivo foi analisar os resultados anatômicos e funcionais da fratura de Colles para descobrir os valores de parâmetros individuais correspondentes ao melhor desfecho funcional. Métodos Este estudo prospectivo incluiu 70 pacientes idosos com fratura de Colles. Todos os pacientes foram tratados de forma conservativa. Os parâmetros anatômicos foram a angulação dorsal, a inclinação radial e a altura radial, avaliados de acordo com Stewart et al. O resultado funcional foi avaliado segundo a tabela de pontuação de pulso Mayo. Os resultados foram analisados por meio do teste de associação do qui-quadrado, considerando o valor de p< 0,001 estatisticamente significativo. A força das associações foi analisada por razões de possibilidades com intervalos de confiança de 95%. Resultados Excelentes e bons resultados anatômicos e funcionais foram obtidos em 68,5% e 78,5% dos casos, respectivamente, com diferença estatística significativa (p= 0,0009). Dos três parâmetros anatômicos, a angulação dorsal inferior a 10° e a perda da inclinação radial inferior a 9° apresentaram associação estatisticamente significativa com os resultados funcionais (p= 0,0006), mas não a perda de altura radial inferior a 6 mm (p= 0,0568); no entanto, a perda da altura radial inferior a 4 mm foi associada de forma significativa aos desfechos funcionais (p= 0,00062). Conclusão As fraturas com redução anatômica apresentam melhores desfechos funcionais. Os parâmetros anatômicos limítrofes aceitáveis para a obtenção de resultados funcionais excelentes ou bons são angulação dorsal inferior a 10°, perda da inclinação radial inferior a 9° e perda da altura radial inferior a 4 mm.

Treatment Of Fractures And Its Complications By Traditional Bone Setters: In A Tertiary Care Hospital.

Background: Fracture of bone is a persistent problem encountered in orthopedic practice globally and its management depends on reduction and immobility at the fracture site. Traditional bone setters are accepting this procedure as a familiar custom to formulate their own methods and practices for the management of fractures. Aim of the Study: The aim of the study is to evaluate and manage the complications occurred during the treatment given by TBS. Methods: One hundred and twenty cases coming to OPD during the period of Aug.2014 to Nov.2016 with some kind of prior treatment received from TBS are included in the study. Each case was subjected to detailed clinical and radiological examinations to evaluate the outcomes of the interventions by TBSs. Results: Malunion is the predominant form of presentation with 54 cases (46%) followed by non union in 24 (20%) cases. 33 cases (28%) presented with impending ischemia at initial stages of treatment. 8 cases (6%) presented with chronic osteomylitis and infected nonunion. Eventually 13 cases ended with gangrene and amputation. Cost of surgery emerged as the major cause (42%) followed by fear of surgery (23%) to receive treatment from TBS. Conclusion: The results in our study vindicate the fact that TBS play a major role in providing health care to the fracture patients. Multiple factors contribute to the wide spread acceptance of TBS in society. Lack of knowledge about the basic anatomy and referral system by TBS is responsible for complications. So it is required to create public awareness and integrating TBS in the healthcare system through proper training and due legislation is the possible aim to be achieved.