Development of De Quervain’s Tenosynovitis After Distal Radius Fracture
Thomas John Carroll, MD1; Brianna Caraet, MD1; Norman Madsen, MD1; Danielle M Wilbur, MD2
1University of Rochester, Rochester, NY; 2University of Rochester Medical Center, Rochester, NY
Introduction: The purpose of our study is to determine the risk factors for the development of De Quervain’s Tenosynovitis after distal radius fractures. Our hypothesis is that longer periods of immobilization, operative intervention, higher energy fracture patterns, and shorter duration of physical therapy will correlate with the development of De Quervain’s.
Methods: This is a 10-year retrospective study of 1451 consecutive patients with distal radius fractures presenting to a large academic institution. The incidence and relative risk of De Quervain’s tenosynovitis within one year of sustaining a distal radius fracture was analyzed. Demographic information, fracture pattern, treatment method, length of immobilization, and duration of physical therapy were recorded. Statistical calculations comparing distal radius fractures and traumatic versus atraumatic De Quervain’s cohorts were conducted using unpaired T-test and Chi-square analysis.
Results: In total, 41 patients developed post-traumatic De Quervain’s Tenosynovitis. Among the operative cohort, the incidence was 2.2% (relative risk, 2.4; 95% CI, 1.4-3.8), and that of the non-operative group was 3.8% (relative risk, 4.2; 95% CI, 2.5-6.3). The diagnosis was made on average 209.7 days after injury and 42% of fractures were OTA type 23-C. Patients among both groups were immobilized for 43.5 days and participated in 7.1 physical therapy sessions on average. Among all affected patients, 78% admitted to strenuous, overuse activities or careers. Compared to the unaffected cohort, the De Quervain’s group was more likely to be female (83% vs 66%; p=0.02) and black (14.6% vs 5.1%; p<0.01) with similar age (53.7 vs 57.4; p=0.2) and BMI (28.7 vs 27.6; p=0.3). Post-traumatic De Quervain’s was successfully treated with NSAIDs alone (5.5%), splinting (12.2%), cortisone injections (70.1%), or surgery (12.2%). Compared to those with atraumatic De Quervain’s, the traumatic cohort was less likely to respond to corticosteroid injections (64.5% vs 81.5%; p=0.04). Of those ultimately requiring surgery, 100% were noted to have a separate extensor pollicis brevis (EPB) sheath (relative risk, 2.5; 95% CI, 2.2-2.8).
Conclusion: Non-operative distal radius fracture patients were 4.2 times more likely to develop De Quervain’s than the general population, and 2.4 times more likely for those treated operatively. These patients were more likely to be female, black, and engaging in strenuous overuse activities or careers. They demonstrated higher energy fracture patterns and worse response to corticosteroid injections, more frequently requiring surgical decompression. Among those requiring surgery, patients were 2.5 times more likely to have a separate EPB sheath compared to those with atraumatic Quervain’s.
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