Review Question - QID 219906

In middle-aged and geriatric women, formal hand therapy has been shown to improve early, but not late functional outcomes, including improved Disabilities of Arm, Shoulder and Hand (DASH) scores, active range of motion, and lower pain scores compared to self-directed exercise programs.

Volar locking plate fixation has become the standard fixation choice for many surgeons in the operative treatment of distal radius fractures. Open reduction and internal fixation of distal radius fractures have improved early function over non-operative management for select injuries. Despite literature demonstrating no difference in clinical outcomes between operative and non-operative management for fractures in elderly patients over 65 years of age, some patients may benefit from operative fixation for comminuted, intra-articular fractures or with the goal of achieving early mobilization. Additionally, supervised hand therapy has been demonstrated to improve DASH scores and active range of motion in females over 40 as opposed to self-directed exercise programs.

Gamo et al. performed a small randomized control trial of 57 women over 40. The patients were randomized into groups receiving either formal hand therapy or a self-directed exercise program. The patients who received formal hand therapy demonstrated improved DASH scores, active range of motion, and lower VAS pain scores at 6 weeks, but equalized by 6 months.

Valdes et al. performed a prospective study investigating the efficacy of supervised clinic-based therapy and self-directed home exercise programs. They found no differences between groups regarding grip strength and Patient-Rated Wrist Hand Evaluation (PRWHE) scores. They conclude by recommending the use of formal hand therapy for patients with noteworthy complications or hand and wrist stiffness.

Figure A is an AP wrist radiograph demonstrating volar locking plate fixation of a comminuted, intra-articular distal radius fracture.

Incorrect Answers:
Answer 1: Suture type has no impact on patient-reported outcomes in the treatment of distal radius fractures.
Answer 3: Concomitant carpal tunnel release is indicated in a patient with symptoms of acute carpal tunnel syndrome. In the absence of acute carpal tunnel syndrome, carpal tunnel release is not indicated and is not associated with improved early patient-reported outcomes.
Answer 4: The use of two distal rows of locking screw fixation is indicated on a per-fracture basis based on the quality of fixation, but has no association with patient-reported outcome measures.
Answer 5: Patients undergoing distal radius fracture fixation should not be allowed to fully weight-bear in the early postoperative period, as immediate weight-bearing may lead to loss of fixation.