Report on Hands from Doctors Demystify, April 2011
CONTENTS
DD Courses
How does treatment of distal radius fractures affect depression?
Canadian Society of Hand Therapists Annual Meeting
The Journal of Rejection and other April 1 fun
DOCTORS DEMYSTIFY THE SHOULDER on a Saturday in a City Near You
Atlanta April 2
Chicago, Portland, and Vancouver BC April 9
New Orleans April 16
Houston April 23
Minneapolis, Pittsburgh, Cleveland, Rochester NY April 30
Boston, Denver, San Diego May 7
Dallas May 14
San Francisco, New York May 21
Baltimore June 4
Cincinnati June 11
Learn from surgeon specialists
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Register immediately and on line for maximum economy
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Find full course objectives, topics, and registration at www.doctorsdemystify.com
JOURNAL ARTICLE REVIEW Does early return to ADLs after volar
plating of distal radius fractures reduce depressive symptoms?
Investigators in Korea studied 26 patients undergoing volar plating (VP) and 24 age- and
gender-matched patients undergoing cast immobilization (CI) for unstable distal radius
fractures. Their hypothesis was that early return to daily activities in the VP group would
reduce depressive symptoms.
Patients in the VP group wore a short arm plaster splint for the first week and then a
removable splint. They started hand therapy 2 weeks after injury. Patients in the CI group
wore a sugar-tong splint or short arm cast for 6 weeks and then switched to a removable
splint and started hand therapy.
All patients answered questionnaires at 0, 2, 6, 12, and 24 weeks. These included the
DASH, an assessment of depressive symptoms, and a pain numerical rating scale.
Over all, 76% of the patients at time of injury and 48% at 2 weeks had scores indicating a
major depressive disorder. These percentages dropped progressively as time went on. At
no point, however, were the depression scores significantly different between VP and CI
groups.
The VP group had significantly better pain scores at 12 and 24 weeks and significantly
better DASH scores at 24 weeks, otherwise the CI and VP groups fared similarly at all
other time points for functional ability and comfort.
The presence of pain proved to a significant predictor of depression at 0 and 24 weeks. A
high DASH score (higher is worse) was a significant predictor of depression at 6 weeks.
Study weaknesses included that there were no pre-fracture depression scores, that the 2
groups started hand therapy at different times, and that other predictors of depressive
symptoms such as social support, level of education, and socioeconomic status were not
studied.
The take home message for me is that patients with distal radius fractures are likely
depressed. Volar plating with early return to daily activities may reduce pain and improve
functional scores but will not alleviate their depression. Recognizing this likelihood, we
should let the patients know that depression in this situation is common and encourage
them to seek professional help.
Gong et al: Comparison of depressive symptoms during the early recovery period in
patients with a distal radius fracture treated by volar plating and cast immobilization.
Injury. 2011 Feb 8. [Epub ahead of print]
CANADIAN SOCIETY OF HAND THERAPISTS
The CSHT annual meeting is in Vancouver April 29-20, 2011. Details of the meeting are
attached.
If you have courses or meetings you would like to have announced here, let me know.
DD CELEBRATES THE FIRST OF APRIL
Have a look at http://www.universalrejection.org/
And let me know which of the following papers you would like me to review next month.
Simultaneous Fusion of the MCP, PIP, and DIP joints for Rheumatoid Arthritis - The
Post Procedure
'Smart' Implants - the Impact of Interactive Microchips and iPad Technology on Finger
Joint Reconstruction
Bioresorbable External Fixators for Distal Radius Fractures
Closed Treatment of Dorsal Wrist Ganglions. Which works better: Kindle or iPad?
Syndactyly Release Without Skin Grafting. Technique and Functional Outcome in a Bat
Forelimb Model
Strength, Gliding Properties, and Favored Rehabilitation Protocol for a 57-Strand Flexor
Tendon Repair
Best wishes,
Roy A. Meals, MD
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