Published 1/1/2011

Pain a factor in forearm disability

Pain and worrying about pain may account for much of the long-term disability seen in patients who have sustained forearm fractures, according to a Dutch study presented at the 2010 annual meeting of the American Society for Surgery of the Hand by Arjan G.J. Bot of the Academic Medical Center in Amsterdam.

The researchers evaluated 71 patients an average of 21 years after injury. At the time of injury, most of the 35 patients who were skeletally immature were treated conservatively, with closed reduction and cast immobilization. Most of the 36 patients who were skeletally mature at injury were treated with plate-and-screw fixation. Most patients (46) had simple (type A) fractures; 7 patients had comminuted (type C) fractures and 18 patients had type B fractures, including wedge fragment.

At an average 21 years after injury, the average Disabilities of the Arm, Shoulder and Hand (DASH) score for all patients was 8 points (range: 0 to 54); 72 percent of patients reported no pain. The average rotation and wrist flexion/extension on the injured side were 91 percent of the uninjured side, and average grip strength was 94 percent of the uninjured side. The researchers noted small but significant differences in rotation and wrist flexion/extension between skeletally mature and immature patients, but found no significant differences in disability between the two groups.

The research team found that the best predictors of DASH score were worry about pain, pain, and grip strength, which accounted for 55 percent of the variation in DASH scores. Pain by itself accounted for 40 percent of the variation.

Other members of the research team for “Long-term Outcomes of Fractures of Both Bones of the Forearm” included Job N. Doorn-berg, MD, PhD; Anneluuk L.C. Lindenhovius, MD, PhD; David C. Ring, MD, PhD; J. Carel Goslings, MD, PhD; and C. Niek van Dijk, MD, PhD.

Disclosure information: Mr. Bot, Drs. Doornberg, Lindenhovius, and Goslings—no conflicts; Dr. van Dijk—Boehringer Ingelheim, GlaxoSmithKline, Stryker, Biomet; Dr. Ring—Acumed, LLC; Biomet; Wright Medical Technology; Illuminos; Mimedex; Stryker.

Bottom Line

  • Both skeletally mature and skeletally immature patients who sustain forearm fractures regain most of their motion and grip strength, regardless of whether they are treated surgically or nonsurgically.
  • This small, retrospective study found that disability correlated with pain and worry about pain rather than motion.