Predictors of limited forearm rotation following conservative treatment of distal radius fractures: a retrospective comparative study

Background: Limitations in forearm rotation resulting from distal radius fracture are often neglected in clinical practice. We aimed to explore possible influencing factors of forearm rotation limitation following conservative treatment of these fractures.

Methods: A series of patients with distal radius fractures who underwent conservative treatment in the Third Hospital of Hebei Medical University were retrospectively enrolled. Basic patient information and data on post-reduction imaging parameters and specific treatment strategies were collected. Ranges of forearm pronation and supination motion were recorded at 6-month and 12-month follow-ups. Univariate and multivariate logistic regression analyses were used to identify factors associated with forearm rotation limitation.

Results: A total of 118 enrolled patients, 49 patients (41.5%) had limited forearm rotation function at the 6-month follow-up. Analysis of the fracture and cast fixation characteristics revealed that involvement of the sigmoid notch (odds ratio [OR], 7.010; 95% confidence interval [CI], 1.572-31.249), immobilization > 6 weeks (OR, 2.524; 95% CI, 1.044-6.099), and pronation fixation (OR, 1.797; 95% CI, 1.082-2.985) were associated with limited forearm rotation. Among patients with sigmoid notch fractures, there were no significant differences in forearm pronation or supination motion between the 6-month and 12-month follow-ups. At the 12-month follow-up, there was less supination function in patients with > 6 weeks of immobilization than in those with < 6 weeks of immobilization (P = 0.012), with no significant difference in pronation function (P = 0.131). At the 6-month follow-up, the degree of forearm supination was significantly lower in the fixed pronation position than in the neutral (P = 0.001) or supination (P < 0.001) positions, with no significant differences in the degree of forearm pronation among the three groups (P = 0.166). At the 12-month follow-up, no significant differences in pronation (P = 0.257) or supination (P = 0.164) were found among the three groups.

Conclusions: Sigmoid notch involvement, immobilization > 6 weeks, and pronation fixation were influencing factors of post-fracture limitation in forearm rotation. The effects of these factors on pronation and supination were not completely consistent and exhibited varying duration.