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

Abstract

Objective Primarily to determine mid‐term functional outcome for patients with distal radius fracture (DRF) and to compare this between operative and conservatively managed patients. Secondarily to examine for differences in age, gender and number of instability factors between management groups. Methods Eligible patients (age 18 years or more, closed DRF managed to completion of care within Monash Health), presenting between 1 January and 31 December 2016. Completion of the patient‐rated wrist evaluation (PRWE) questionnaire was sought at 6–12 months post‐injury. Management was noted (operative or conservative). Age, sex and number of defined instability factors present (dorsal angulation >20°, intra‐articular fracture, associated ulna fracture, dorsal comminution, radial shortening >2 mm) are reported and compared between management groups. Results Of 369 eligible patients, 199 (54%) completed a PRWE. Median age was 60 years (interquartile range [IQR] 45–71), 150 (75%) were women, median number of instability factors present was 2 (IQR 1–4) and 45 (23%) underwent operative management. Difference in PRWE scores between operative and conservatively managed patients was not significant (20 [IQR 7–36] vs 16 [IQR 5–35]). Differences in age and gender between management groups were not significant. Significantly more in the operative group had presence of four or more instability factors (44% [95% confidence interval 30–60] vs 20% [14–27]). Conclusion The mid‐term median PRWE score was 18 (IQR 5–36). This was not significantly different between operative and conservatively managed patients. Operation was more likely when four or more instability factors were present.

Long-term subjective results and radiologic prognosis of a distal radius fracture in working-aged patients – a prognostic cohort study of 201 patients

“… 30 Another retrospective study reported excellent functional results in 67% of operatively treated patients, 5 and in a study of mid-term (6–12 months post-injury) functional outcome in adult patients with DRF between operative and non-operative treatment, no significant difference was found between operative and non-operative groups. 31 The main results of the previous studies are summarized in Supplemental Table S2 . Both operatively and non-operatively treated patients managed well at a minimum of four years after DRF in the present analyses.…”

Analysis of Our Open Reduction and Internal Fixation of Distal Radius Fractures in Adults: Are We Over Operating?

“…Other studies with comparable age groups to those of cohorts 1 and 2 have shown to have a good correlation in patientrated wrist evaluation (PRWE) in nonoperative when compared with operative management. 15 In their recent guidelines, the BOA and BSSH outline ulnar variance and dorsal tilt as the most important radiological parameters in extra-articular fractures, with the addition of an intra-articular step for intra-articular fractures. Our data analysis has dorsal tilt being the parameter that most often met the guideline's "threshold for intervention."…”