Association between Functional Outcomes and Radiographic Reduction Following Surgery for Distal Radius Fractures.

Background: Quality of reduction in distal radius fractures (DRF) is assessed using radiographic parameters, however few studies examine the association between radiographic measurements and functional outcomes. Our purpose was to evaluate the relationship between radiographic measurements and clinical outcome measures following surgery for DRF using detailed testing to demonstrate further associations between post-surgical radiographic measurements and function. Methods: Measurements were performed on postoperative radiographs of 38 patients following ORIF of DRF. Measurements included: radial inclination, radial height, ulnar variance, volar tilt, radiocarpal interval (d2/w2), and the intra-articular step-off. Clinical outcome measures included motion, grip strength, functional dexterity testing, Moberg pick-up test, specific activities of daily living, DASH score, pain scale, manual-assessment questionnaire. Results: Different radiographic parameters correlated with different specific tasks. The parameter correlated with most functional tasks was ulnar-variance. Radial inclination, radial-styloid scaphoid distance, and fracture classification correlated with some functions. Intraarticular step-off, and radial height were not associated with functional testing. Conclusions: Surgical radiographic results may affect post-operative function. Detailed task specific testing may enable a better evaluation of surgical outcomes. Further study and refinement of functional assessment may change our surgical goals in DRF.

Responsiveness of the Manual Ability Measure-36 (MAM-36): changes in hand function using self-reported and clinician-rated assessments.

OBJECTIVE. To examine the responsiveness of the Manual Ability Measure-36 (MAM-36) compared with a clinician-administered functional assessment. METHOD. The MAM-36 was administered to 46 patients (Cohort A, n = 20; Cohort B, n = 26) with various upper-extremity conditions. All patients received occupational therapy intervention for 2-37 wk and were retested at discharge. Additionally, the Smith Hand Function Test (SHFT), including task performance speeds and grip strength measurements, was administered to Cohort B at intake and discharge. RESULTS. Manual ability improved significantly at discharge in all patients. Patients also showed significant improvement on the SHFT. The correlation between gain in MAM-36 and gain in grip strength was moderate. The standardized response mean for the MAM-36 was 1.18. CONCLUSION. The MAM-36 was responsive to changes in hand function in patients receiving occupational therapy services. MAM-36 results correlated positively with improvements in task performance speeds and grip strength.