Examination of Temporal Changes Based on the Presence or Absence of Ulnar-Sided Pain in Patients with Distal Radius Fractures

Shunichi Terashita, Momo Otsu, Kanato Haruuchi, Kazuya Umeyama, Takuya Kawai, Masahiko Toyama, Yasutaka Yoshinaka, Hiroki Matsukawa, Yoshiki Nishikawa, Taisei Morobayashi, Moe Ando
Purpose:

This study aimed to determine whether the presence or absence of ulnar-sided pain at 12 weeks post-surgery affects the progress in patients who have undergone volar locking plate fixation after distal radius fractures.

Methods:

This study included 28 patients who underwent volar locking plate fixation for distal radius fractures at our hospital between September 2018 and September 2019. The average age was 74.8 years (range: 61-89 years), with 4 males and 24 females. Of these, 19 had right-side fractures and 9 had left-side fractures. Patients were divided into two groups based on the presence or absence of ulnar-sided pain at 12 weeks. The evaluation items included wrist ROM (dorsiflexion, palmar flexion, radial deviation, ulnar deviation), forearm pronation, supination, grip strength ratio, PRWEJ, and QuickDASH scores at 4 and 12 weeks post-surgery. The differences in each evaluation item were calculated as the difference between the 4-week and 12-week values. An independent t-test and Mann-Whitney U test were used to compare the two groups, with a significance level set at 5%.

Results:

In the group with ulnar-sided pain at 12 weeks, the average ROM changes were: dorsiflexion 49.6°/61.7°/12.1°, palmar flexion 51.7°/57.9°/6.3°, radial deviation 16.7°/21.3°/4.6°, ulnar deviation 34.2°/34.6°/0.4°, pronation 71.3°/79.2°/7.9°, and supination 67.1°/85.0°/17.9°. Their grip strength ratio was 0.5/0.6/0.2, PRWEJ was 48.8/33.5/-15.3, and QuickDASH was 48.9/28.8/-20.0. In contrast, the group without ulnar-sided pain showed the following averages: dorsiflexion 50.9°/62.5°/11.6°, palmar flexion 48.1°/57.2°/9.1°, radial deviation 16.6°/19.4°/2.8°, ulnar deviation 31.9°/37.2°/5.3°, pronation 77.2°/85.3°/8.1°, and supination 75.9°/84.7°/8.8°. Their grip strength ratio was 0.6/0.7/0.2, PRWEJ was 44.4/18.7/-25.7, and QuickDASH was 44.8/20.6/-24.1. The group with ulnar-sided pain showed a significantly larger change in supination and higher PRWEJ scores at 12 weeks, indicating worse outcomes in terms of pain and recovery.

Conclusion(s):

This study suggests that ulnar-sided pain at 12 weeks affects both the change rate in pronation and the PRWEJ score. Although the group with ulnar-sided pain initially had poorer supination ROM at 4 weeks, their ROM improved by 12 weeks to match that of the pain-free group. PRWEJ scores at 12 weeks were influenced by pain, likely due to its impact on the pain-related items of the questionnaire.

Implications:

The presence or absence of ulnar-sided pain at 12 weeks can influence both the recovery of supination ROM and patient satisfaction. Physiotherapy interventions should consider ulnar-sided pain to improve patient outcomes and satisfaction. Adjustments in treatment based on pain can optimize recovery after distal radius fractures.

Funding acknowledgements:
This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Keywords:
Distal radius fracture
Ulnar-sided pain
Temporal changes
Primary topic:
Musculoskeletal: upper limb
Second topic:
Orthopaedics
Third topic:
Other
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
The study was approved by Daito Central Hospital Ethics Committee, and informed consent was obtained following the Declaration of Helsinki.
Provide the ethics approval number:
2019-B
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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