The Journal of Bone and Joint Surgery (American). 2007;89:2619-2624.
doi:10.2106/JBJS.F.01065
© 2007 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the exam for this article:
 Trauma Test 20: Winter 2008 (publication date February 15, 2008; expiration...
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Google Scholar
Right arrow Articles by Droll, K. P.
Right arrow Articles by McKee, M. D.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Droll, K. P.
Right arrow Articles by McKee, M. D.
Related Collections
Right arrow Adult Trauma
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

Outcomes Following Plate Fixation of Fractures of Both Bones of the Forearm in Adults

Kurt P. Droll, MD, FRCS(C)1, Philip Perna, MD1, Jeff Potter, BSc1, Elaine Harniman, BSc(PT)1, Emil H. Schemitsch, MD, FRCS(C)1 and Michael D. McKee, MD, FRCS(C)1

1 St. Michael's Hospital, 55 Queen Street East, Suite 800, Toronto, ON M5C 1R6, Canada. E-mail address for M.D. McKee: mckeem{at}smh.toronto.on.ca
Investigation performed at St. Michael's Hospital, Toronto, Ontario, Canada

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Two commercial entities (St. Michael's Hospital and the University of Toronto) paid or directed in any one year, or agreed to pay or direct, benefits of less than $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Internal fixation of diaphyseal forearm fractures has been associated with high union rates and satisfactory forearm motion. The purpose of this study was to investigate patient-based functional outcomes and to objectively measure strength following plate fixation of fractures of both bones of the forearm.

Methods: Range of motion, quantitative strength measurements, and validated outcome measures—i.e., DASH (Disabilities of the Arm, Shoulder and Hand) and SF-36 (Short Form-36) scores—were assessed in a cohort of thirty patients (nineteen men and eleven women with a mean age of 43.9 years) treated with plate fixation for fractures of both bones of the forearm. The mean duration of follow-up was 5.4 years, and standardized radiographs of the forearm were evaluated. Univariate and multivariate analyses were performed to identify determinants of the DASH and SF-36 Physical and Mental Component Summary (PCS and MCS) scores.

Results: Compared with the uninjured arms, the injured arms had reduced strength of forearm pronation (70% of that of the normal arm, p < 0.0001), forearm supination (68%, p < 0.0001), wrist flexion (84%, p = 0.0011), wrist extension (63%, p < 0.0001), and grip (75%, p < 0.0001). In addition, the injured arms had a significantly reduced active range of forearm supination (90% of that of the uninjured arm, p = 0.0001), forearm pronation (91%, p = 0.0028), and wrist flexion (82%, p < 0.0001). The mean DASH score (18.6 points; range, 0 to 61 points) was significantly higher than the normative value in the United States (p = 0.02). Limitations in strength correlated with worse DASH and SF-36 PCS scores. Pain and a work-related injury were independent determinants of the DASH score.

Conclusions: Stabilization with internal plate fixation following fracture of both bones of the forearm restores nearly normal anatomy and motion. However, a moderate reduction in the strength of the forearm, the wrist, and grip should be expected following this injury. Perceived disability as measured with the DASH and SF-36 questionnaires is determined by pain more than by objective physical impairment.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?