Clinically meaningful improvements in outcomes can be expected for 12 months, after which progress plateaus and reaches normal values. This paper adopted a novel approach to meta-analyses in that the research question was of a longitudinal nature, which required a unique method of statistical analysis. Cite this article: 2017;99-B:1665-76.

Introduction Driving performance, as assessed using a driving simulator, after distal radius fracture has not been previously studied. Our aims were to undertake a pilot study to assess feasibility via: (i) acceptability of driving simulation for this assessment purpose, (ii) recruitment and retention, (iii) sample size calculation. Preliminary evaluations of differences in driving performance between individuals recovering from distal radius fracture and controls were conducted to confirm if the methodology provided meaningful results to aid in justification for future studies. Methods Driving performance of 22 current drivers (aged 21–81 years), recruited by convenience sampling, was assessed using a driving simulator. The fracture group included those recovering from distal radius fracture managed with open reduction and internal fixation using a volar plate. The control group were uninjured individuals. Assessment was performed approximately five weeks post-surgery and follow-up assessment two weeks later. Acceptability outcome measures included pain and simulator sickness scores, feasibility measures included retention rates and measures of driving performance included time spent speeding, time spent out of the lane, standard deviation of lateral position and hazard reactions. Results The assessment was completed by 91% of participants; two participants dropped out secondary to simulator sickness. Retention rates were 83%. Preliminary results suggest those with distal radius fracture spent more time out of the lane and less time speeding. Conclusion This method was sensitive, acceptable and feasible according to the parameters of this pilot study. The results from this small sample suggest that between-group differences in driving performance are measurable using driving simulation five weeks following distal radius fracture.

Introduction: The primary aim of this review was to identify literature that examined factors which influence driving performance following a wrist fracture. Given the known scarcity of research in this area, secondary aims were to detail current practices including the driving habits of patients following a wrist fracture and health professionals' opinions on safe return to driving. Methods: We performed a search in April 2015 using three electronic databases to obtain relevant literature in the English language. Relevant studies including clinical trials, surveys and case reports were reviewed. Results: The search identified 12 relevant studies. Five of these were clinical studies with a crossover design that investigated the driving ability of uninjured individuals with the wrist immobilised in a cast. The remaining were surveybased studies. The clinical trials showed that the presence of a wrist cast reduced driving performance in uninjured individuals. No studies investigated driving performance in individuals with a wrist fracture. The surveys showed that this patient group returns to driving despite perceived safety risks. Inconsistency in expert opinions on whether individuals with a wrist fracture are safe to drive was highlighted. Conclusions: There is evidence to suggest that driving performance is reduced in uninjured individuals when wearing a cast immobilising the wrist; however, the influence of wrist fracture is unknown. This, along with safety implications resulting from current driving behaviours and inconsistent information provided to patients regarding return to driving, highlights the need for further studies to ascertain which factors influence driving performance following wrist fracture.