Analysis Of Correlative Factors Affecting The Recovery Of Distal Radius Fractures By Limited Open Reduction And External Fixation Combined With Kirschner Wire

Objective:To study the correlative factors influencing functional recovery in patients with a distal radius fracture treated by limited open reduction and external fixation combined with kirschner wire.Methods:From January 2010 to January 2014,107 patients with distal radius fractures in the second affiliated hospital of Dalian Medical University were treated with the limited open reduction and external fixation combined with Kirschner wire fixation, and constantly followed up after the surgery,and the wrist range of motion, grip strength, and functional outcome by the Michigan hand score were assessed 3, 6,and12 months after surgery. The factors assessed for their influence on functional recovery include sex,age,bone mineral density(BMD),hand dominance,the type of fracture, the energy of trauma, the time to surgery, whether the merger of ulnar styloid fracture,the duration of external fixation, the duration of Kirschner wire fixation.The results of follow-up data were analyzed statistically by SPSS17.0 software, A multivariate regression analysis was conducted to identify independent predictors of delayed functional recovery in terms of grip strength, the wrist range of motion and the Michigan hand score.Statistical significance was accepted at P less than 0.05.Results: There was a heavily decrease in grip strength in patients with an increase in age, a decrease in BMD, high-energy trauma,a severe fracture type,and increase in duration of external fixation at months 3(P=0.02,0.02,0.01,0.01 and 0.02, respectively). At months 6, grip strength decrease was closely related with an increase in age, a decrease in BMD, high-energy trauma and a severe fracture type(P=0.01,0.02,0.03 and 0.03, respectively), whereas only an increase in age and a decrease in BMD reduced grip strength at month 12(P=0.03 and 0.02, respectively). A high-energy trauma, severe type fracture and increase in duration of external fixation reduced the wrist range of motion at month 3(P=0.02,0.02 and 0.01, respectively), whereas only a severe fracture type was closely related with a decreased range of motion after 6 and 12 months(P=0.02 and 0.02,respectively). severe type fracture, high-energy trauma and increase in duration of external fixation reduced functional outcomes at months 3(P=0.02,0.02 and 0.03, respectively). At months 6, severe type fracture and high-energy trauma reduced functional outcomes(P=0.04 and 0.03, respectively). Conversely, an increase in age and a decrease in BMD reduced functional outcome at month 12(P=0.03 and 0.02,respectively). According to the multivariate regression analysis, severe fracture type, high-energy trauma and increase in duration of external fixation reduced functional outcome at month 3(R2=37%,P=0.02, and severe fractures, high-energy trauma, and a decrease in BMD reduced it at month 6(R2=33%,P=0.03). Conversely, at month 12, an increase in age and a decrease in BMD reduced functional outcome(R2=31%,P=0.03).However, the duration of Kirschner wire fixation and whether it is combined with ulnar styloid fractures of distal radius fractures have no obvious correlation for the recovery of wrist function after 3, 6,and12 months of surgery.Conclusions:1.Severe type fracture and high-energy trauma were associated with decreased functional outcomes up to 6 months after surgery. 2. An increase in age and a decrease in BMD were the main risk factors affecting wristjoint function recovery up to 12 months after distal radius fracture surgery. 3. The duration of external fixation was associated with decreased functional outcomes up to 3 months after surgery. 4. The duration of Kirschner wire fixation and whether it is combined with ulnar styloid fractures of distal radius fractures have no obvious correlation for the recovery of wrist function.