Hand stiffness following distal radius fractures: who gets it and is it a functional problem?

In order to identify predictors for hand stiffness following distal radius fractures and understand the consequences of this common clinical finding, we studied 260 patients. Our null hypothesis was that we would find no predictors of post injury hand stiffness.

Baseline demographics and injury characteristics were obtained at distal radius fracture presentation. Treatment and healing was documented. Stiffness was defined as tip to palm distance greater than 1 cm for any one finger. Outcome parameters obtained at regular intervals included wrist and hand range of motion, radiographs, visual analog pain scales, and Disability of the Arm Shoulder and Hand (DASH) questionnaires.

Forty-nine of 260 patients (19%) patients were considered to be "stiff" by our criteria. Grip strength was weaker for stiff patients as well. Patient demographics were similar in both groups with the "stiff" cohort having a greater mean age, p = 0.05. There was no significant difference in stiffness seen in operative cases versus nonoperative cases. Injury ulnar variance was 3.1mm (SD = 3.5) in the "stiff" cohort and 1.8 (SD = 2.9) in the "non-stiff" cohort (p= 0.02). Functional disability as measured by the DASH differed (p = 0.001) between stiff and non-stiff patients for both 6 month and 1 year follow-up time points. Stiff patients were more likely than non-stiff patients to have lower grip strength at 12-month post fracture (p = 0.001).

Older patients who present with significant ulnar variance at injury are more likely to experience hand stiffness at some time during their recovery. The development of hand stiffness is associated with poorer functional outcome than those who do not develop stiffness.