Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years.

Twenty-five sedentary, low-demand patients older than 60 years were retrospectively evaluated for function and radiographic results following nonoperative treatment of displaced distal radius fractures. The mean age was 72 years and the average follow-up period was 34 months. All patients had radiographic and functional evaluations. The radiographic assessment included a scoring system based on measurements of the final dorsal angle, loss of radial length, and the final radial inclination. The development of radiocarpal and distal radioulnar joint arthrosis was also investigated. The functional assessment included subjective and objective criteria. Overall satisfaction, ability to return to previous activity level or occupation, concern over wrist appearance, and a functional task questionnaire were part of the subjective assessment. Objective assessment included neuromuscular evaluation and measurements of range of motion and grip strength. The final radiographic scores revealed that 6 patients (24%) had excellent results, 11 (44%) had good results, 2 (8%) had fair results, and 6 (24%) had poor results. Six of 10 patients with intra-articular fractures developed progressive wrist arthrosis. Two of 6 patients with radiographic arthrosis had unsatisfactory functional outcome. Five of 8 patients with intra-articular fractures that healed with a residual stepoff >/=2 mm had satisfactory functional outcome; 3 of these 8 patients had unsatisfactory functional outcome. The functional assessment revealed that 22 patients (88%) had excellent or good results and 3 (12%) had fair or poor results. The radiographic outcome did not correlate with the functional outcome. Twenty-three of 25 patients (92%) were satisfied with the overall outcome of the treatment and 22 (88%) were able to return to their previous activity level or occupation. Despite an obvious clinical deformity in over half of the patients, none were unhappy with the clinical appearance of the wrist. According to the functional task questionnaire, jar opening was by far the most difficult task to perform after fracture healing. Functional outcome was satisfactory in most cases; a high level of personal satisfaction and return to previous activity level was observed, regardless of the radiographic result. Nonoperative treatment of distal radius fractures yields satisfactory outcome, especially in those with low functional demands. It also is indicated in poor operative candidates. (J Hand Surg 2000; 25A:19-28.

Arthrodesis of the spastic wrist.

The clinical and radiographic results of 9 patients (11 wrists) who had wrist arthrodeses for severe spastic flexion contracture were evaluated. The spasticity was due to cerebral palsy, traumatic head injury, and cerebrovascular accident. All wrist deformities were aesthetically unappealing and the patients or their caretakers had difficulty with hygiene or function. The subjective evaluation included overall satisfaction, hand hygiene, wrist deformity, functional improvement, and willingness to have surgery again given the same preoperative circumstances. A standardized hand function questionnaire was used to determine functional improvement following surgery. The objective evaluation included clinical evidence of fusion, skin condition, wrist position, and radiographic assessment. The average age of the patients was 22 years at the time of surgery and the average follow-up period was 32 months. All patients were satisfied with the results of the surgery and hygiene improved in all cases. None had palmar skin maceration or breakdown. All patients or their caretakers rated the overall appearance or wrist and hand deformity as improved and all but one patient would agree to have the surgery over again given the same preoperative circumstances. According to a 17-task hand function questionnaire, 8 of 9 patients (10 wrists) reported improved function after surgery. Face washing, propelling a wheelchair, and picking up both large and small objects were among the most frequently improved functions. Radiographic fusion was present in all cases. The average position of wrist fusion was 15 degrees flexion and the average amount of wrist correction was 85 degrees. Improved appearance, hygiene, and a certain degree of upper extremity function, regardless of cognitive abilities, can be expected following arthrodesis for severe spastic wrist deformity.

Arthroplasty for trapeziometacarpal arthrosis.

We evaluated twenty-eight patients (30 thumbs) after ligament reconstruction arthroplasty for trapeziometacarpal arthrosis. The mean age was 60 years, 86% were women, and the average follow up was 38 months. Subjective results showed excellent (40%) or good (57%) pain relief in 97% of patients. Return to previous work or activity level was achieved in 98%. Overall satisfaction was observed in 86% of patients, mostly because of pain relief. Functional improvement was reported for many activities except for jar opening, which continued postoperatively to be the most difficult task to perform. Thumb mobility improved postoperatively. Key pinch strength showed an overall decrease of 27%. Proximal migration of the thumb metacarpal measured 27% and radial subluxation measured 1%. Thumb metacarpophalangeal joint hyperextension was present in > 50% preoperatively and in 7 of 30 thumbs postoperatively. Hyperextension was prevalent among women on hormone replacement therapy including three patients who had recurrence of these deformities in spite of attempts to stabilize this joint during surgery.

Ligament reconstruction arthroplasty for trapeziometacarpal arthrosis.

Twenty-eight patients (30 thumbs) were evaluated after ligament reconstruction arthroplasty for trapeziometacarpal arthrosis. The mean patient age was 60 years, 86% were women, and the average follow-up period was 38 months. Subjective results showed excellent (40%) or good (57%) pain relief in 97% of patients. Return to previous work or activity level was achieved in 98%. Eighty-six percent of patients expressed overall satisfaction with the surgical outcome, mostly because of pain relief. Functional improvement was reported for many activities, except jar opening, which continued to be the most difficult task to perform. Thumb mobility improved, while key pinch strength showed an overall decrease of 27%. Proximal migration of the thumb metacarpal measured 27%, and radial subluxation was negligible. Thumb metacarpophalangeal joint hyperextension was present to some degree in more than 50% of patients before surgery and in 7 of 30 thumbs (23%) after surgery. Hyperextension was prevalent among women on hormone-replacement therapy, including 3 patients in whom these deformities recurred in spite of attempts to stabilize their joints during surgery.