Long-term outcomes and complications associated with operative and nonoperative treatment of distal radius fractures. Do we need to restore anatomy to have satisfactory clinical outcome?

A i m: The aim of this study was to assess long-term outcomes and complications associated with conservative and operative treatment of distal radius fractures and to determine if restoration of radio- graphic parameters influences functional outcomes. I n t r o d u c t i o n: Distal radius fractures (DRFs) are common injuries associated with many complications. Numerous studies suggest that operative treatment with anatomic reduction and restoration of radiographic parameters leads to better functional outcomes than nonsurgical treatment.Materials and Methods: We enrolled 207 patients with isolated DRF (mean age 64 ± 17.9 years, women 150 (72.5%)) to our retrospective, single-center study (101 treated operatively, 106 treated non-operatively). There were no significant differences in sex, age, AO type fracture between study groups. After 3.9 ± 1.6 years (mean ± SD) clinical, functional and radiological assessment was conducted using Disabilities of the Arm, Shoulder and Hand (DASH), Patient Rated Wrist Evaluation (PRWE), 9-Hole Peg Test (9-HPT), grip and pinch strength tools. R e s u l t s: We found higher rates of malunion in nonoperative group (p <0.0001) and worse radiologic parameters such as volar tilt (p <0.0001), teardrop angle (p <0.0001) versus operative cohort. Nevertheless radiological parameters were not correlated with DASH and PRWE results. Moreover, patients aged 50 years and above treated operatively had similar functional outcomes (DASH, PRWE) to those treated nonoperatively. C o n c l u s i o n s: Restoration of anatomic and thus radiologic parameters of radius may not be obligatory to achieve satisfactory functional outcome in patients with DRF aged 50 years or above. Patient is the most important 'factor' in determining appropriate and successful treatment method of distal radius fractures.

Restoration of hand function and ability to perform activities of daily living following surgery for carpal tunnel syndrome.

BACKGROUND: The aim of the study was to assess treatment efficacy in patients following surgery for carpal tunnel syndrome and compare hand function with patients' subjective evaluation and their ability to carry out activities of daily living. MATERIAL AND METHODS: The study involved patients undergoing rehabilitation at the Malopolska Region Hand Rehabilitation Centre at L. Rydygier Specialized Hospital in Cracow and at the Hand Rehabilitation Unit at the Scanmed Medical Centre in Cracow. The patients were admitted to the Centre after surgical release of the transverse ligament of the wrist. Fifty hands (40 patients) were evaluated and treated. The rehabilitation programme was customised for each patient, and included patient education, a programme of home-based exercises and physiotherapeutic treatment in our centres. The patients were evaluated twice: before starting rehabilitation and at the end of the treatment. Hand function was evaluated using Swanson's method, the Alderson-McGall Hand Function Questionnaire and the Nine Hole Peg Test. Patients were also asked to provide a subjective evaluation of the typical signs and symptoms of CTS. RESULTS: The study showed improvement in all tests and a high level of correlation between various evaluations of hand function and patients' subjective feelings. CONCLUSIONS: The time at which post-operative rehabilitation was started significantly affected the outcomes of rehabilitation in the study group. There was a significant correlation between hand function impairment and subjective feelings of the patients vs. their quality of daily living.

Upper limb joint mobility ranges during activities of daily living determined by three-dimensional motion analysis--preliminary report.

BACKGROUND: Analysis of hand therapy programmes used in various hand therapy centres shows that the programmes primarily aim to restore a maximum range of motion, although basic activities of daily living do not often require full joint mobility. This report of our investigations, which commenced in 2003, presents the results of an evaluation of the range of motion in the joints of the upper limb, including both proximal and hand joints, during selected daily activities. MATERIAL AND METHOD: Right-handed students of physical therapy were examined using a three-dimensional motion analysis system in the Biokinetics Laboratory of the Division of Biomechanics at the University of Physical Education in Kraków. Spatial registration of movement focused on three daily activities that primarily involve the upper limb, namely, natural movements associated with combing, closing a zip fastener and answering a telephone call. Angular changes in the joints recorded in three movement planes were used as analysis inputs. RESULTS: The range of motion in the analysed joints during daily activities never reached the respective maximal values, usually centering around the middle point of the ranges. CONCLUSIONS: Daily activities require only limited mobility in the upper limb joints. Three-dimensional motion analysis is a useful tool to monitor and assess this phenomenon. The results of such assessments should be taken into account by hand therapists designing and implementing rehabilitation programmes.

Physiotherapy after thumb extensor tendon repair in Verdan zone III. Case study.

BACKGROUND: Finger tendon injuries represent very common consequences of hand injuries and, if not properly treated, can lead to substantial hand function impairment and interfere with activities of daily living. This article presents the results of rehabilitation of a female patient after thumb extensor tendon injury in Verdan's zone III. MATERIAL AND METHODS: Based on standard diagnostic work-up (assessment of the active range of motion), we calculated the degree of functional hand function impairment according to Swanson's method. The diagnostic procedures also comprised measurements of dynamometric grip strength and precise grasp. The examinations were performed on four occasions, the first one during the first visit, and the last one a month after completion of the rehabilitation treatment in our Centre. RESULTS: Test results were used to design the treatment programme, which included among others the author's modification of Kleinert's dynamic reverse thumb splinting, peg-board exercises, physical therapy, individual therapy and home-based exercises. CONCLUSIONS: 1. The modified dynamic splint of our design fulfilled its task as both a preventive and therapeutic measure. 2. The dynamic splinting programme administered enabled early initiation of post-operative rehabilitation, which led to a very high degree of recovery of thumb and hand function. 3. The functional recovery outcomes achieved by our patient indicate the advisability of routine incorporation of full dynamic splinting in post-operative rehabilitation programmes of patients with thumb extensor tendon injuries.