OTA 2004 Posters

Functional Outcome and Objectively Measured Strength after Plate Fixation of Fractures of Both Bones of the Forearm in Adults

Kurt Droll, MD, MSc¹ (a-St. Michael's Hospital Scholarship Fund);

Philip Perna, BSc¹; Alison McConnell, MSc (Eng)²; Dorcas Beaton, BScOT, PhD²; Emil Schemitsch, MD^1,2; Michael D. McKee MD^1,2;

¹University of Toronto; ²St. Michael's Hospital; Toronto, Ontario, Canada

Purpose: The functional outcome and strength of patients after plate fixation of diaphyseal fractures of the radius and ulna is unknown. Therefore, the purpose of this study was to investigate functional outcome and objectively measured strength of patients who had undergone plate fixation of fractures of both bones of the forearm (BBOF).

Methods: Research Ethics Board approval was obtained for the study. Twenty-five subjects (19 men and 6 women with a mean age 47.6 years (range, 20 to 71) treated with plate fixation for fractures of BBOF were clinically and radiographically reviewed. The mean duration of follow-up was 5.7 years (range, 2 to 13.4). The postoperative protocol included short-term immobilization followed by active-assisted range of motion and strengthening starting between 4 and 6 weeks. All subjects were assessed in person at follow-up with a detailed examination of strength of their injured and non-injured arms. Isometric muscle strength was objectively measured with the Baltimore Therapeutic Equipment work simulator (model WS-20). Standardized anteroposterior and lateral radiographs were obtained of both forearms.

Results: Strength of elbow flexion (72% of that of the non-injured arm, P <0.0001), elbow extension (84%, P = 0.0004), forearm supination (75%, P = 0.005), forearm pronation (69%, P <0.0001), wrist flexion (81%, P = 0.009), wrist extension (62%, P <0.0001), and grip (70%, P <0.0001) were all significantly reduced in the injured arm. Mean (± SE) DASH and Gartland-Werley scores were 19.5 ± 4.0 (range, 0 to 61) and 4.04 ± 0.91 (range, 0 to 15), respectively. Eighty-eight percent of the patients (22/25) scored good to excellent on the Gartland-Werley scale. No statistical difference in mean maximal radial bow (MRB) between injured and non-injured arm was found (mean ± SE, 1.42 ± 0.07 vs. 1.58 ± 0.05, respectively) or in location of MRB (61% vs. 59%).

Conclusion/Significance: Restoration of anatomic alignment with stable internal fixation after BBOF fracture results in good-to-excellent functional outcome. Despite this outcome, significant reduction in strength of the elbow, forearm, wrist and grip should be expected after this injury and is an area for potential improvement in postoperative care.