Clinical and functional outcome of malunited distal radius fractures: a single-centre observational study from a tertiary care hospital in Northern India

Abstract

Background: Distal radius fractures are among the most common skeletal injuries encountered in orthopedic practice. Malunion is a recognized complication resulting in altered wrist biomechanics and functional impairment. Epidemiological and outcome data from tertiary care hospitals in North India remain limited.

Methods: This hospital-based, single-centre, observational descriptive study was conducted in the Department of Orthopaedic Surgery, Balrampur Hospital, Lucknow, over six months (February-July 2025). Fifty-eight adult patients with radiologically confirmed distal radius malunion were enrolled. Clinical assessment included pain evaluation on a Visual analogue scale (VAS), wrist range of motion measured with a goniometer, and grip strength measured using a hand dynamometer. Radiological parameters—dorsal/volar tilt, radial height, radial inclination, and ulnar variance—were measured on standard wrist radiographs. Functional outcomes were assessed using the Disabilities of the arm, Shoulder and hand (DASH) score, Patient-rated wrist evaluation (PRWE) score, Modified mayo wrist score (MMWS), and the Gartland–Werley demerit score. Pearson and Spearman correlation coefficients were used to assess associations between radiological and functional parameters; p<0.05 was considered statistically significant.

Results: The mean age of participants was 44.6±12.8 years, with a male predominance (62.1%). The most common injury mechanisms were fall on an outstretched hand (46.6%) and road traffic accident (41.4%). Mean dorsal tilt was 18.6±5.2°, radial shortening 6.4±1.9 mm, and positive ulnar variance +3.1±1.2 mm. Affected wrist grip strength was reduced by approximately 25% relative to the contralateral limb. Mean VAS pain score was 5.6±1.8. Mean DASH and PRWE scores were 42.3±11.7 and 48.9±13.4, respectively, indicating moderate-to-severe functional disability. Significant correlations were demonstrated between dorsal tilt, radial shortening, and ulnar variance with both DASH and PRWE scores (r=0.42–0.51; p<0.01).

Conclusions: Malunited distal radius fractures produce significant functional impairment that correlates meaningfully with radiographic deformity. Combined radiological and patient-reported outcome assessment is essential for informed management planning. Early recognition of unacceptable fracture alignment and timely intervention may prevent long-term disability.