Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures

doi:10.1016/j.jhsa.2004.07.002

The Journal of Hand Surgery

Volume 29, Issue 6, November 2004, Pages 1121-1127

https://doi.org/10.1016/j.jhsa.2004.07.002 Get rights and content

Purpose

There have been few prospective studies of elderly patients with conservatively treated distal radius fractures and little is known about the relationship between acceptable radiographic reduction and functional outcomes in this population. We hypothesized that acceptable fracture reduction (according to standard radiographic dorsal/volar tilt criteria) would be associated with better functional outcomes and greater satisfaction.

Methods

Seventy-four patients who were at least 50 years of age with conservatively managed distal radius fractures were recruited from 2 large urban emergency departments from January 2001 to December 2001. Patients with wrist fractures treated in the emergency department and discharged home were included; patients admitted to the hospital or who required surgical reduction were excluded. Standard lateral radiographs were taken after the final cast was removed. These were reviewed independently by a reference-standard musculoskeletal radiologist and the degree of dorsal/volar tilt was recorded. This value was dichotomized according to standard published dorsal/volar tilt criteria as acceptable (dorsal tilt <10° or volar tilt <20°) or unacceptable (dorsal tilt >10° or volar tilt >20°). The Medical Outcomes Study Short-Form 12 (SF-12); the Disabilities of the Arm, Shoulder, and Hand questionnaire; and a patient satisfaction survey were used to assess patient-reported outcomes 6 months after the injury.

Results

The average dorsal/volar tilt measured by the reference standard radiologist was 3.4° (SD = 13.6) dorsal; overall 47 patients (64%) were considered to have an acceptable radiographic reduction. Acceptable radiographic reduction was not associated with better generic physical or mental health status, lesser degrees of upper-extremity disability, or greater satisfaction with outcomes than was unacceptable reduction. Overall 44 of 74 patients (59%) reported being satisfied or very satisfied with their functional status at 6 months.

Conclusions

Contrary to our hypotheses we found that acceptable radiographic reduction (according to dorsal/volar tilt criteria) was not associated with better self-reported functional outcomes or increased satisfaction at 6 months in elderly patients with conservatively treated distal radius fractures.

Section snippets

Subjects and setting

From January 2001 to December 2001 we recruited patients from the emergency departments of 2 large urban tertiary-care hospitals. Patients who were at least 50 years of age with a unilateral, conservatively treated distal radius fracture were eligible for inclusion. Distal radius fractures were defined as those occurring within 2 cm of the distal end of the radius.¹¹ Patients who refused or were unable to provide informed consent, were unable to communicate in English, had bilateral distal

Results

Over a 1-year period radiographic and self-reported functional outcome data were collected for 74 patients. The mean ± SD age was 69 ± 12 years with a range of 50 to 96 years. Most (82%) were women and 92% of the population was white. The vast majority of patients were right handed, 45% of fractures involved the dominant hand, and all injuries were reported as secondary to a fall. There were no statistically significant differences in baseline characteristics between those patients with and

Discussion

Our data do not support the hypothesis that unacceptable reduction according to dorsal/volar tilt criteria is associated with poorer functional outcomes or dissatisfaction with treatment for wrist fractures in elderly patients. When comparing patients with acceptable radiographic reduction to those with unacceptable radiographic reduction we found no statistically significant or clinically important differences in the SF-12 PCS, SF-12 MCS, DASH, or satisfaction scores at 6 months. Given the

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Previous studies have suggested little association between radiographic malalignment and long-term functional outcomes of nonsurgical treatment of distal radius fractures in geriatric patients. However, no report has stratified the elderly by age and focused on short-term outcomes. The purpose of this study was to determine how the relationship between malunion and patient outcomes differs between early- and late-geriatric patients in the short and long terms after injury, thereby informing explanations and decision-making on treatment options for geriatric patients with distal radius fractures.
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Citation Excerpt :
Studies have suggested that malunions involving dorsal angulation, ulnar variance, and radial height tend to have worse outcomes.39–43 However, multiple studies have also suggested that clinically important differences in the outcomes are not associated with anatomic radiographic reduction parameters and that other factors may play a more important role.27,44–52 This study supports that near-anatomic reduction, especially at the time of long-term follow up, may provide no clinically important additional benefit.
Although baseline biopsychosocial factors are associated with short-term patient-reported outcomes following distal radius fracture open reduction internal fixation (ORIF), their effect on mid-term outcomes is unclear. We aimed to evaluate the effect of social deprivation, previously established as a surrogate for depression, pain interference, and anxiety, on quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores >1 year following distal radius ORIF.
Adult patients (≥18 years) with an isolated distal radius fracture treated with ORIF by orthopedic trauma and hand surgeons at a single tertiary academic center over a 3-year period were included. Outcomes at ≥1 year postoperatively were evaluated using QuickDASH. Age, follow-up duration, area deprivation index (ADI; a measure of social deprivation), subspecialty (hand vs trauma), and postoperative alignment were assessed using linear regression with 95% confidence intervals after bootstrapping and a permutation test for P values to test for their association with the final QuickDASH score.
Follow-up data were obtained for 98 of 220 (44.5%) patients at a mean of 3.1 ± 1.0 years after surgery. Mean age and ADI were 53.2 ± 15.4 years and 26.8 ± 18.7, respectively. Most fractures were intra-articular (67.3%), and 72.4% had acceptable postoperative alignment parameters, as defined by the American Academy of Orthopaedic Surgeons clinical practice guidelines. The mean QuickDASH score was 13.0 ± 16.5. There were no significant associations between the final QuickDASH score and any studied factor, including ADI, as determined using univariable analysis. Multivariable analysis showed no association between ADI and the final QuickDASH score, independent of age, sex, treating service, follow-up duration, and fracture alignment or pattern.
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One hundred and forty patients who presented to our clinic between April 2017 and March 2019 were randomly divided into two groups: 70 received reverse sugar tong (RST group) and 70 received below arm cast (BAC group). Clinical and radiological follow-up was performed 7–10 days, three weeks, 5 or 6 weeks, 12 weeks and one year after the treatment. Clinical outcomes including wrist range of motion, complication rates, Health Assessment Questionnaire (HAQ) score at end of treatment, Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaire and Mayo Elbow Performance score (MEPS) score at 12 weeks and last follow-up.
Finally, sixty-five patients were treated with BAC, and their average age was 58.2 years and sixty-two patients with an average age of 57.4 years were treated with RST were completed the radiological and clinical one-year follow-up. There were no significant differences in range of motion, radiological parameters, the Q-DASH and MEPS scores between the groups the 12th week and last visit; however, the HAQ score was significantly higher in the cast group during the 6th visit (p < 0.001). The BAC group had a higher complication rate (40%) than the RST group (19.3%) (p = 0.01).
Patient treated with RST had a higher functional status at end of treatment and lower complications when comparing traditional below arm cast.
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: Supported by grants from Alberta Heritage Foundation for Medical Research [AHFMR] and the Alberta Medical Association/Alberta Health and Wellness MSB Innovation Fund.

: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Original articlesDistal radius fracturesRadiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures

Purpose

Methods

Results

Conclusions

Section snippets

Subjects and setting

Results

Discussion

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Ther

J Hand Surg

J Hand Surg

Eval Program Plann

J Hand Surg

J Hand Surg

J Hand Surg

Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk factors. The study of osteoporotic fractures

J Am Geriatr Soc

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Mayo Clin Proc

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Original articles
Distal radius fractures
Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures