Optimizing Physical Function Following Distal Radius Fracture

Distal Radius Fracture (DRF) is one of the most frequent of all human bone fractures. Wrist and/or finger range of motion (ROM) and grip strength are standard outcome measures used by clinicians to evaluate recovery after a hand injury. ROM is considered to be an important component of joint mobility and relates to measures of functional impairment and disability. Impaired wrist and hand ROM are related to a decrease in grip strength, grasp ability, fine manipulation, and hand function. The relationship between ROM and other physical impairments as they relate to patient-rated outcomes after DRF have not been well identified. The thesis includes three studies. The first study (Chapter 2) is a systematic review and meta analysis of existing literature on the effects of laser irradiation on bone regeneration, suggesting that low power laser can enhance biomechanical indicators of bone during fracture healing in animal models. The second study (Chapter 3) explores the intra-rater, inter-rater, and inter-instrument reliability and construct validity of two digital electro goniometers to measure active wrist and active/passive index finger ROM in patients with limited wrist and/or hand. The results of this study demonstrate that digital goniometry is highly reliable for all measures across occasions, raters and instruments. The moderate correlation between individual joint motions and patient-rated self-reported function suggests that joint motion impairments contribute to functional disability. The third study (Chapter 4) has a specific focus on the relationship between physical impairment outcome measures and patient-rated wrist pain and function in early and late stages after distal radius fracture. Wrist flexion, extension, supination, pronation, grip strength, age and gender, were found to contribute significantly with wrist pain and function. Good wrist arc of motions (close to normal) and moderate grip strength must be recovered to have optimal wrist functional outcomes after distal radius fracture. The thesis concludes with a discussion of the next steps required toward understanding effective mechanisms to promote bone healing and earlier function after DRF, which may lead to more effective patient-centered treatment protocols. Keywords: Bone Healing, Distal Radius Fracture, Physical Impairment, Patient-Rated Wrist Evaluation