Kiran Sasi, P (2009) Functional and Radiological Outcome of Neglected Diaphyseal both Bones Forearm Fractures in Adult Treated with Plate Osteosynthesis. Masters thesis, Christian Medical College, Vellore.
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Abstract
AIMS AND OBJECTIVES: The aims and objectives of the study are: • To retrospectively analyze all cases of adult neglected forearm treated with open reduction and plate osteosynthesis from January 2000 to October 2007 • To assess the functional outcome of patients • To assess the clinical outcome the affected forearm and compared to the opposite normal limb • To assess the radiological union • To assess the maximal radial bowing and the location of the maximum radial bow and the relationship with forearm function. STUDY DESIGN: This is a cross sectional study with retrospective case selection. A total of 21 patients were recruited for this study between August 2007 and August 2008. METHODS: One-to-one interviews were conducted for obtaining the relevant history and applying the DASH questionnaire. Clinical examination was. MRC grading was used to assess the motor power. Standardized goniometer was used for the assessment of range of movement of the elbow, forearm and wrist. Neglected forearm fracture was defined as forearm fractures for which definitive surgical intervention was undertaken at least one month after the event. Standardized antero-posterior and lateral plain radiographs were obtained. Measurement of the maximum radial bow was calculated based on the formula described by Schemitsch and Richards. The location of maximum radial bow also was calculated. The plain radiographs of the affected forearm taken at the time of presentation were reviewed for evaluating the fracture configuration and classifying the fractures based on the AO/OTA system of classification for forearm fractures. Inpatient records of the selected cases were obtained to ascertain the details of the surgical procedure and the details of the peroperative period and immediate postoperative period. RESULTS: There was statistically significant correlation between DASH scores and patients range of supination (p=0.006), wrist palmar flexion (p=0.016) and maximum radial bow (p=0.045). There was statistically significant correlation between the time of operation from injury and wrist dorsiflexion (p=0.003).There was strong statistically significant correlation between the AO classification of the fractures and nerve palsy (p=0.001). There was significant correlation between DASH score and nerve palsy (p=0.035). Strong statistical significance was found when maximum radial bow (p= <0.001) and the location of the maximum radial bow (p= 0.017) was correlated with forearm pronation signifying that loss of maximum radial bow and alteration in the location of the maximum radial bow results in loss of forearm pronation. All the 21(100%) patients had achieved full clinical and radiological union at follow up irrespective of the delay in presentation or any other local or systemic factors. CONCLUSION: Open reduction and plate osteosynthesis is seen to be a very good modality of treatment diaphyseal both bones forearm fractures in adult and as per this study and has resulted in 100% fracture union even in late presentation when reviewed at a mean follow up of 36.76 months. A delay in definitive fixation results in significant wrist and finger dysfunction. DASH is a widely accepted standardized scoring system to assess upper limb function and correlates strongly with forearm supination. Reconstruction of the maximum radial bow to near normal (8.08 ± 2.46) and the anatomic location of the restored maximum radial bow are vital in restoration of forearm function even in patients with delayed treatment.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Functional and Radiological Outcome ; Neglected Diaphyseal ; Bones Forearm Fractures ; Adult ; Plate Osteosynthesis. |
| Subjects: | MEDICAL > Orthopaedics |
| Depositing User: | Subramani R |
| Date Deposited: | 21 Sep 2017 02:36 |
| Last Modified: | 21 Sep 2017 02:36 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3051 |
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