Modifiable Factors Associated With Chronic Pain 1 Year After Operative Management of Distal Radius Fractures

Abstract

Key Points Question What are modifiable preoperative factors associated with developing chronic pain after distal radius fracture surgery? Findings In this secondary analysis of a randomized clinical trial with 146 participants, each 10-point increase in preoperative pain score was associated with 17% increased odds of chronic pain, and a 1-week delay in surgical intervention was associated with more than triple the odds of experiencing chronic pain. Internal fixation was associated with decreased risk of chronic pain compared with external fixation or pinning. Meaning In this study, earlier time to surgery, adequate preoperative pain control, and internal fixation were associated with lower risk of chronic pain development among patients with distal radius fracture who were treated surgically.

Does time to surgery for distal radius fractures impact clinical and radiographic outcomes? A systematic literature review

“…The significant differences in PROMs were found at a surgical delay of seven days or more and two different PROM tools were utilized, DASH 23,28 and The Michigan Hand Outcomes Questionnaire 16 . Clinical outcomes included increased finger and thumb stiffness (>2 wk delay), 20 decreased functional outcomes in flexion and ulnar deviation at a delay of greater than one week, 23 and more than triple the odds of experiencing chronic pain with a one-week delay to surgery 24 . One study found that surgeons reported greater procedural difficulty with a delay greater than one week 16 .…”

“…Time to surgery evaluated and the definition of delay varied by publication, with 13% of studies defining delay within one week of injury, 47% after one week, 27% after two weeks, and 13% after three weeks or longer (up to 25 days after injury). Only five (33%) of the included studies provided reasons for delay that included: administrative and capacity related reasons such as operating room availability, [21][22][23][24] delayed patient presentation, 21,22 and injury severity. 23,24,31 Trial Outcome Measures Ten (67%) trials found no significant difference in time to surgery as defined by delayed and non-delayed groups.…”

“…Only five (33%) of the included studies provided reasons for delay that included: administrative and capacity related reasons such as operating room availability, [21][22][23][24] delayed patient presentation, 21,22 and injury severity. 23,24,31 Trial Outcome Measures Ten (67%) trials found no significant difference in time to surgery as defined by delayed and non-delayed groups. In addition, 80% of trials lacked an a priori power analysis for statistical analysis.…”

“…Among the five trials that found significant differences in time to surgery, four trials found significant differences at a surgical delay of greater than one week, 16,23,24,28 and one trial found significant differences in patients with a surgical delay of greater than two weeks. 20 One study reported radiographic significance, 23 three studies reported significant differences among PROMs, 16,23,28 and all five studies reported differences in clinical outcomes 16,20,23,24,28 (Table 3). The significant differences in PROMs were found at a surgical delay of seven days or more and two different PROM tools were utilized, DASH 23,28 and The Michigan Hand Outcomes Questionnaire.…”

“…16 Clinical outcomes included increased finger and thumb stiffness ( > 2 wk delay), 20 decreased functional outcomes in flexion and ulnar deviation at a delay of greater than one week, 23 and more than triple the odds of experiencing chronic pain with a one-week delay to surgery. 24 One study found that surgeons reported greater procedural difficulty with a delay greater than one week. 16 Another study found that patients who had surgery within seven days of injury had better short-term PROMs and clinical outcomes, with the delayed group showing significantly worse DASH scores, grip strength, and wrist motion at twelve weeks, but at 48 wk there were no significant differences between groups.…”