Volar locking plate fixation of distal radius fractures: Isokinetic assessment of the influence of an ulnar styloid process fracture on pronation-supination strength
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Abstract
Although distal radius fractures (DRF) are frequent, the management of associated
ulnar styloid process (USP) lesions is still controversial. According to recent studies,
a fracture of the USP does not appear to affect functional outcomes after treatment
of a DRF with plate fixation. We sought to compare the impact of a USP fracture on
pronation and supination strength in isometric and isokinetic tests. We included patients
with a DRF who underwent volar locking plate fixation. We divided our population into
three groups: one group consisted of patients who had a fracture of the USP base,
one group composed of patients without USP fracture or with a distal ulnar fracture
only, and a control group composed of subjects with normal wrists. Inclusion criteria
included an age of 18 to 50 years and a minimum follow-up of 10 months post-surgery.
The main exclusion criteria were complex intraarticular fractures and postoperative
complications. The assessment was based on clinical examination and recording of forearm
rotation strength during pronation and supination in isokinetic and isometric tests.
The ratio between the operated and contralateral sides was compared for each patient.
Thirty-six participants were included (mean age 31.1±4.5 years). The mean postoperative
follow-up was 17.9±6.9 months. Participants with a USP fracture differed from other
participants in their peak torque on the isokinetic test at 45°/s for pronation and
supination, but not on isokinetic tests at 120°/s or in isometric tests. Isokinetic
tests revealed a decrease in pronation-supination strength during sustained effort
for patients with associated basal USP fractures. These findings may have clinical
implications for management of the USP but need to be specified with further study.
LEVEL OF EVIDENCE: prognostic study level III.