Patterns of forearm fractures and their treatment outcomes in adult patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: The forearm is a complex anatomic structure serving an integral role in upper extremity function. The dexterity of the upper limb depends on a combination of hand and wrist function and forearm rotation. Thus, fractures of the radius and/or ulna alter the congruency and range of motion of the forearm. The outcomes of treatment methods of forearm fractures in adult patients at MTRH have not been published. This study sought to identify the causes, treatment modalities and functional outcomes of forearm fractures. The information in this study will help improve care to the patients with forearm fractures. Objective: To describe the patterns of forearm fractures, treatment methods and the functional outcomes in adult patients at MTRH. Methods: A prospective descriptive study conducted from January 2015 to December 2015 at MTRH. Patients with forearm fractures who met the inclusion criteria were recruited consecutively and followed on their treatment modality for six months to determine the outcomes. An interviewer administered questionnaire was used to collect data on the demographics, cause of fracture, and pattern of fracture, treatment modality and outcomes. DASH questionnaire was used for functional outcomes. Data was entered into MS Excel then exported to STATA V.13 for analysis. Categorical variables were summarized as frequencies and percentages. Continuous variables were summarized as mean (SD) and median (IQR). Mann-Whitney U test was used for comparison of median DASH Scores among different variables. Results were presented in prose, tables and figures. Results: A total of 98 patients were recruited into the study, with an age range of 18-85 years and a mean of 41.9 years (SD 16.6). There were 55 males and 43 females (male: female ratio of 1.3:1). The causes of fractures were falls in 46 patients (47%), Road Traffic Accident in 28 patients (29%), assault in 18 patients (18%) and other causes were found in 6 patients (6%). Closed fractures were found in 82 patients (84%) while open fractures were found in 16 patients (16%). There were 51 radius fractures (52%), 21 ulna fractures (21.4%) while both radius and ulna fractures were found in 26 patients (26.5% of the cases). Non-operative treatment in the form of cast immobilisation was done in 74 patients (76% of the cases). Twenty four patients (24%) received operative treatment by open reduction and internal fixation (ORIF), out of which 21 patients were treated by plating. The median DASH score at 6 months for non-operative patients was 11.2 (IQR 7.5, 20), while for the operative patients was 18.4 (IQR 5.8, 25). Conclusion: Falls were the leading causes of forearm fractures and the radius was the most commonly fractured bone with distal radius metaphyseal fractures being the commonest. Majority of the fractures were treated non-operatively and had good functional outcome by DASH score. Operative treatment was done for open fractures, both bones and complex fractures. ORIF by plating was the main method of operative treatment and yielded good functional outcome by DASH score at six months follow up. Recommendations: Patterns of forearm fractures should be a guide to the surgeons on the treatment methods. Though short term outcomes were good, studies on long term functional outcomes are recommended.