Similar 1-year subjective outcome after a distal radius fracture during the 10-year-period 2003–2012

Abstract

Background and purposeDuring the last decades, treatment of distal radius fractures (DRFs) has changed, with surgical intervention being more common and with new techniques. We investigated whether this change has influenced the subjective outcome. Here we report, year by year, the 1-year score after a DRF over a 10-year-period, using a patient-reported outcome measure.Patients and methodsPatients aged 18 years or more with a DRF between 2003 and 2012 were prospectively and consecutively registered in a longitudinal outcome database. 1 year after the fracture, all the patients were sent a validated subjective outcome questionnaire, the Disabilities of the Arm, Shoulder, and Hand (DASH). The lower the score (0–100), the better the outcome.ResultsBetween 2003 and 2012, 3,666 patients (2,833 of them women; mean age 62 (18–98) years) were included. 22% were operated and the rate remained constant over the years. The surgical methods shifted from external fixators (42%) and fragment-specific plates (45%) in 2003, to mainly volar locking plates (65%) in 2012. 70% of the patients responded to the 1-year DASH questionnaire. The median DASH score was 9 (IQR: 2–25) for the cohort, both in surgically treated patients (9 (IQR: 3–25)) and in non-surgically treated patients (9 (IQR 2–27)). Subgroup analysis showed a higher median DASH score for women than for men; for patients with AO type C fractures rather than type B or type A fractures; for patients with external fixation or fragment-specific fixation than for those who underwent surgery using volar locking plates; and for patients who were operated by a general orthopedic surgeon rather than a hand surgeon.InterpretationThe shift in surgical treatment had no influence on the subjective outcome for the cohort.

Functional outcome and management pathways for adult patients presenting to an Australian health service with distal radius fracture

“…This result is consistent with the international literature, which generally reports mid‐term PRWE or DASH scores of 10–20 point, which are similar between operative and conservatively managed groups . An apparent exception to this result is the New Zealand study of Barai et al ., which reported a statistically significant difference in 30 month functional outcome in favour of conservative over operative management .…”

“…With regard to general management practices, the two international studies which included the total adult DRF population reported operative rates of 20–25% . The more numerous studies which only included patients with an initially displaced DRF reported operative rates of 40–55% .…”

“…Some further ‘mid‐term’ gains are reported at six to 12 months, with relatively little additional ‘long‐term’ (>12 months) improvements . For this reason, ‘mid‐term’ outcome is most frequently reported in the literature …”

“…To date, most DRF studies have compared a range of outcomes between defined patient subgroups . By contrast, there is a paucity of literature describing general management and reasons for treatment choice in all patients presenting to the ED with DRF . There is no information on this in the Australian setting.…”

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

“…In general, medium-term functional outcome can be assumed to reflect the effect of treatment, with long-termfollow-up being influenced by other conditions, events, or patient factors that in turn could influence functional outcome scores. Reports have shown that the DASH score after distal radius fracture treatment tends to plateau after 12 months 54,55. The previous meta-analyses have mainly focused on elderly patients.…”