Influence of palmar tilt on wrist palmar flexion range-of-motion limitation after conservative treatment of distal radial fractures

Abstract

Background Distal radial fractures are common forearm injuries. A key rehabilitation objective is achieving adequate wrist palmar and dorsal flexion range-of-motion (ROM). However, few studies have explored this relationship, with even lesser number of studies investigating the impact of distal radius alignment on wrist ROM limitation due to fractures. We aimed to determine the effect of radial alignment on wrist palmar and dorsal flexion ROM after conservative treatment for distal radial fractures.Patients and methods This retrospective, cohort study, included 82 patients with distal radial fractures (11 men, 71 women, mean age: 65.9 ± 16.6 years) who underwent examination at an orthopedic clinic. Wrist ROM limitation was defined as ˂60° of dorsal flexion and ˂55° of palmar flexion. The palmar tilt (PT), radial length (RL), and radial inclination (RI) were radiographically measured. The patient’s age, residual symptoms, and rehabilitation period were extracted from medical records. Univariate and multivariate analyses were conducted with the presence/absence of wrist ROM limitation as the objective variable, with the PT, RL, and RI as explanatory variables. A comparison of age, and rehabilitation period between the groups with and without wrist ROM limitation was performed using the Mann–Whitney U test. The presence/absence of residual symptoms were compared between two groups using the chi-squared test.Results Univariate analysis revealed that PT, RL and RI were associated with palmar flexion ROM limitation. Multivariate analysis showed that PT was the only factor associated with palmar flexion ROM limitation (odds ratio: 0.85, 95% confidence interval: 0.78–0.91, p < 0.001), while dorsal flexion ROM limitation was not associated with any of the three measurements. The group with palmar flexion ROM limitation presented older age (73.1 vs. 59.6 years), higher residual symptom frequency (23 vs. 12 patients), and longer rehabilitation period (159.2 vs. 73.9 days) compared to the group without the limitation (p < 0.01).Conclusion Dorsal displacement of the distal radius induces alterations in the wrist joint motion axis, potentially affecting limitation in palmar flexion ROM. Patients with palmar flexion ROM limitation had more residual symptoms and longer rehabilitation period than those without. These findings may contribute to the development of evidence-based joint ROM exercises, risk management, goal setting, and rehabilitation programs for patients with distal radial fractures.

Keywords

• Distal radial fractures
• palmar flexion ROM limitation
• palmar tilt