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

Abstract

Objective To investigate long-term outcomes associated with distal radius fracture (DRF) in working-aged patients. The authors hypothesized that the majority of patients experience no permanent loss of function when measured with patient-rated wrist evaluation (PRWE). Methods This was a retrospective cohort study of patients with a DRF aged between 18 and 65 years. The primary outcome measure was PRWE score at a minimum of 4 years after DRF. Secondary outcome measures were pain catastrophizing scale (PCS) and radiographic measurements. Results Of 201 patients included, 179 were primarily treated non-operatively with a 5-week cast treatment and 22 were primarily operated. The mean follow-up duration was 5 years. The mean PRWE score was 10.9 (95% confidence interval 8.4, 13.4) and median PRWE was 3.5 (interquartile range, 0.0–13.0). There was minor correlation between PCS and PRWE score (correlation coefficient [CC] 0.3), and between PRWE score and dorsal angulation of the fracture measured after closed reduction (CC 0.2) and in one-week follow-up radiographs (CC 0.2). Conclusions Working-aged patients seem to gain nearly normal wrist function after DRF in longer follow-up. Pain catastrophizing appears to correlate with long-term treatment outcome.

Functional outcomes are restored a decade after a distal radius fracture: a prospective long-term follow-up study

“…Five retrospective studies (total n ¼ 517 patients) found no correlation between malunion and PROMs (Catalano et al, 1997;Forward et al, 2008;Goldfarb et al, 2006;Hevonkorpi et al, 2021;Visser et al, 2020). One well-conducted prospective study with a long-term follow-up (63 patients) reported an association between PROMs and malunion (Ali et al, 2018).…”

“…No difference in patient-rated wrist evaluation (PRWE) was noted in a retrospective study analysing operative versus non-operative treatment and malunion ( Hevonkorpi et al., 2021 ). In their study, patients regained normal function in the long term, consistent with our findings.…”

“…Radiological alignment ( Ali et al., 2018 ; Raudasoja et al., 2018 ) and pain catastrophization ( Hevonkorpi et al., 2021 ) have been proposed to affect long-term results. However, there is no evidence linking age ( Raudasoja et al., 2018 ), pseudoarthrosis of the ulnar styloid ( Ali et al., 2018 ), osteoarthritis, ( Ali et al., 2018 ; Visser et al., 2020 ) or treatment method (percutaneous wires vs. plate and operative vs. non-operative) to the long-term outcome of DRFs ( Costa et al., 2019 ; Hevonkorpi et al., 2021 ).…”

Reducing Exposure to X-Ray in Patients With Conservatively Managed Distal Radius Fractures: A Closed-Loop Pilot Audit

“…A recent study in working-aged patients by Hevonkorpi et al. [ 17 ] found that in 179 conservatively managed DRFs, only two patients required operative intervention at a stage later than three weeks post-injury. Furthermore, multiple studies suggest a low rate of operative intervention for DRFs initially managed non-operatively in elderly patients [ 18 - 21 ].…”

“…However, there is evidence in the literature to indicate a low rate of long-term complications in appropriately managed DRFs, with a change in management strategy unlikely to be required. A recent study in working-aged patients by Hevonkorpi et al [17] found that in 179 conservatively managed DRFs, only two patients required operative intervention at a stage later than three weeks post-injury. Furthermore, multiple studies suggest a low rate of operative intervention for DRFs initially managed non-operatively in elderly patients [18][19][20][21].…”