A Unified Approach to Outcomes Assessment for Distal Radius Fractures

Published:March 05, 2016DOI:
      Distal radius fractures are one of the most common upper extremity injuries. Currently, outcome assessment after treatment of these injuries varies widely with respect to the measures that are used, timing of assessment, and the end points that are considered. A more consistent approach to outcomes assessment would provide a standard by which to assess treatment options and best practices. In this summary, we review the consensus regarding outcomes assessment after distal radius fractures and propose a systematic approach that integrates performance, patient-reported outcomes, pain, complications, and radiographs.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Chung K.C.
        • Spilson S.V.
        The frequency and epidemiology of hand and forearm fractures in the United States.
        J Hand Surg Am. 2001; 26: 908-915
        • Nellans K.W.
        • Kowalski E.
        • Chung K.C.
        The epidemiology of distal radius fractures.
        Hand Clin. 2012; 28: 113-125
        • Goldhahn J.
        • Angst F.
        • Simmen B.R.
        What counts: outcome assessment after distal radius fractures in aged patients.
        J Orthop Trauma. 2008; 22: S126-S130
        • Goldhahn J.
        • Beaton D.
        • Ladd A.
        • et al.
        Recommendation for measuring clinical outcome in distal radius fractures: a core set of domains for standardized reporting in clinical practice and research.
        Arch Orthop Trauma Surg. 2014; 134: 197-205
        • Herzberg G.
        • Izem Y.
        • Al Saati M.
        • Plotard F.
        “PAF” analysis of acute distal radius fractures in adults: preliminary results.
        Chirurg Main. 2010; 29: 231-235
        • Herzberg G.
        Acute distal radius fracture: PAF analysis.
        J Wrist Surg. 2013; 2: 95-96
        • McNamara R.L.
        • Spatz E.S.
        • Kelley T.A.
        • et al.
        Standardized outcome measurement for patients with coronary artery disease: consensus from the International Consortium for Health Outcomes Measurement (ICHOM).
        J Am Heart Assoc. 2015 May 19; 4
        • Clement R.C.
        • Welander A.
        • Stowell C.
        • et al.
        A proposed set of metrics for standardized outcome reporting in the management of low back pain.
        Acta Orthop. 2015; 86: 523-533
        • Hoang-Kim A.
        The first international society for fracture repair and international osteoporosis foundation “osteoporosis:from evidence to action” combined symposium and working groups.
        Advances Orthoped. 2010; 2: 15-18
        • Squitieri L.
        • Reichert H.
        • Kim H.M.
        • Chung K.C.
        Application of the brief international classification of functioning, disability, and health core set as a conceptual model in distal radius fractures.
        J Hand Surg Am. 2010; 35: 1795-1805.e1
        • World Health Organization
        International Classification of Functioning, Disability and Health (ICF).
        World Health Organization, Geneva, Switzerland2001
        • Diaz-Garcia R.J.
        • Oda T.
        • Shauver M.J.
        • Chung K.C.
        A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly.
        J Hand Surg Am. 2011; 36: 824-835.e2
        • Margaliot Z.
        • Haase S.C.
        • Kotsis S.V.
        • Kim H.M.
        • Chung K.C.
        A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures.
        J Hand Surg Am. 2005; 30: 1185-1199
        • Bland M.D.
        • Beebe J.A.
        • Hardwick D.D.
        • Lang C.E.
        Restricted active range of motion at the elbow, forearm, wrist, or fingers decreases hand function.
        J Hand Ther. 2008; 21: 268-274
        • Adams B.D.
        • Grosland N.M.
        • Murphy D.M.
        • McCullough M.
        Impact of impaired wrist motion on hand and upper-extremity performance.
        J Hand Surg Am. 2003; 28: 898-903
        • Shauver M.J.
        • Chang K.W.
        • Chung K.C.
        Contribution of functional parameters to patient-rated outcomes after surgical treatment of distal radius fractures.
        J Hand Surg Am. 2014; 39: 436-442
        • Chung K.C.
        • Haas A.
        Relationship between patient satisfaction and objective functional outcome after surgical treatment for distal radius fractures.
        J Hand Ther. 2009; 22: 302-307
        • Souer J.S.
        • Lozano-Calderon S.A.
        • Ring D.
        Predictors of wrist function and health status after operative treatment of fractures of the distal radius.
        J Hand Surg Am. 2008; 33: 157-163
        • Jayadevappa R.
        • Chhatre S.
        Patient centered care—A conceptual model and review of the state of the art.
        Open Health Services and Policy Journal. 2011; 4: 15-25
        • Bertakis K.D.
        • Azari R.
        Patient-centered care is associated with decreased health care utilization.
        J Am Board Fam Med. 2011; 24: 229-239
      1. Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press; 2001.

        • Stucki G.
        International Classification of Functioning, Disability, and Health (ICF): a promising framework and classification for rehabilitation medicine.
        Am J Phys Med Rehabil. 2005; 84: 733-740
        • Black N.
        Patient reported outcome measures could help transform healthcare.
        BMJ. 2013; 346: f167
        • Nelson G.N.
        • Stepan J.G.
        • Osei D.A.
        • Calfee R.P.
        The impact of patient activity level on wrist disability after distal radius malunion in older adults.
        J Orthop Trauma. 2015; 29: 195-200
        • MacDermid J.C.
        • Roth J.H.
        • McMurtry R.
        Predictors of time lost from work following a distal radius fracture.
        J Occup Rehabil. 2007; 17: 47-62
        • Alderman A.K.
        • Chung K.C.
        Measuring outcomes in hand surgery.
        Clin Plast Surg. 2008; 35: 239-250
        • Hoang-Kim A.
        • Pegreffi F.
        • Moroni A.
        • Ladd A.
        Measuring wrist and hand function: common scales and checklists.
        Injury. 2011; 42: 253-258
        • Dowrick A.S.
        • Gabbe B.J.
        • Williamson O.D.
        • Cameron P.A.
        Outcome instruments for the assessment of the upper extremity following trauma: a review.
        Injury. 2005; 36: 468-476
        • Mehta S.P.
        • MacDermid J.C.
        • Richardson J.
        • MacIntyre N.J.
        • Grewal R.
        Baseline pain intensity is a predictor of chronic pain in individuals with distal radius fracture.
        J Orthop Sports Phys Ther. 2015; 45: 119-127
        • Chung K.C.
        • Hamill J.B.
        • Walters M.R.
        • Hayward R.A.
        The Michigan Hand Outcomes Questionnaire (MHQ): assessment of responsiveness to clinical change.
        Ann Plast Surg. 1999; 42: 619-622
        • Chung K.C.
        • Pillsbury M.S.
        • Walters M.R.
        • Hayward R.A.
        Reliability and validity testing of the Michigan Hand Outcomes Questionnaire.
        J Hand Surg Am. 1998; 23: 575-587
        • Chung K.C.
        • Kotsis S.V.
        • Kim H.M.
        Predictors of functional outcomes after surgical treatment of distal radius fractures.
        J Hand Surg Am. 2007; 32: 76-83
        • Kotsis S.V.
        • Lau F.H.
        • Chung K.C.
        Responsiveness of the Michigan Hand Outcomes Questionnaire and physical measurements in outcome studies of distal radius fracture treatment.
        J Hand Surg Am. 2007; 32: 84-90
        • Shauver M.J.
        • Chung K.C.
        The Michigan hand outcomes questionnaire after 15 years of field trial.
        Plast Reconstr Surg. 2013; 131: 779e-787e
        • MacDermid J.C.
        • Turgeon T.
        • Richards R.S.
        • Beadle M.
        • Roth J.H.
        Patient rating of wrist pain and disability: a reliable and valid measurement tool.
        J Orthop Trauma. 1998; 12: 577-586
        • MacDermid J.C.
        • Richards R.S.
        • Donner A.
        • Bellamy N.
        • Roth J.H.
        Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture.
        J Hand Surg Am. 2000; 25: 330-340
        • MacDermid J.C.
        • Roth J.H.
        • Richards R.S.
        Pain and disability reported in the year following a distal radius fracture: a cohort study.
        BMC Musculoskelet Disord. 2003 Oct 31; 4: 24
        • Gummesson C.
        • Ward M.M.
        • Atroshi I.
        The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH.
        BMC Musculoskelet Disord. 2006 May 18; 7: 44
        • Dy C.J.
        • Schmicker T.
        • Tran Q.
        • Chadwick B.
        • Daluiski A.
        The use of a tablet computer to complete the DASH questionnaire.
        J Hand Surg Am. 2012; 37: 2589-2594
        • Waljee J.F.
        • Kim H.M.
        • Burns P.B.
        • Chung K.C.
        Development of a brief, 12-item version of the Michigan Hand Questionnaire.
        Plast Reconstr Surg. 2011; 128: 208-220
        • Ware Jr., J.
        • Kosinski M.
        • Keller S.D.
        A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
        • Ware J.E.
        Improvements in short-form measures of health status: introduction to a series.
        J Clin Epidemiol. 2008; 61: 1-5
        • Ware Jr., J.E.
        • Hays R.D.
        Methods for measuring patient satisfaction with specific medical encounters.
        Med Care. 1988; 26: 393-402
        • Ware J.E.
        • Kosinski M.
        • Keller S.D.
        SF-36 Physical and Mental Health Summary Scales: A User’s Manual.
        The Health Institute, Boston, MA1994
        • Ware Jr., J.E.
        • Sherbourne C.D.
        The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
        • Ware J.E.J.
        • Kosinski M.
        • Keller S.D.
        Physical and Mental Health Summary Scales: A User’s Manual.
        The Health Institute, New England Medical Center, Boston, MA1994
        • Ravin A.G.
        • Gottlieb N.B.
        • Wang H.T.
        • et al.
        Effect of the Veterans Affairs Medical System on plastic surgery residency training.
        Plast Reconstr Surg. 2006; 117: 656-660
        • Revicki D.A.
        • Kawata A.K.
        • Harnam N.
        • Chen W.H.
        • Hays R.D.
        • Cella D.
        Predicting EuroQol (EQ-5D) scores from the patient-reported outcomes measurement information system (PROMIS) global items and domain item banks in a United States sample.
        Qual Life Res. 2009; 18: 783-791
        • EuroQol G.
        EuroQol—a new facility for the measurement of health-related quality of life.
        Health Policy. 1990; 16: 199-208
        • Cella D.
        • Yount S.
        • Rothrock N.
        • et al.
        The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years.
        Med Care. 2007; 45: S3-S11
        • Cella D.
        • Riley W.
        • Stone A.
        • et al.
        The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008.
        J Clin Epidemiol. 2010; 63: 1179-1194
        • Tyser A.R.
        • Beckmann J.
        • Franklin J.D.
        • et al.
        Evaluation of the PROMIS physical function computer adaptive test in the upper extremity.
        J Hand Surg Am. 2014; 39: 2047-2051.e4
        • Overbeek C.L.
        • Nota S.P.
        • Jayakumar P.
        • Hageman M.G.
        • Ring D.
        The PROMIS physical function correlates with the QuickDASH in patients with upper extremity illness.
        Clin Orthop Relat Res. 2015; 473: 311-317
        • Hays R.D.
        • Spritzer K.L.
        • Amtmann D.
        • et al.
        Upper-extremity and mobility subdomains from the Patient-Reported Outcomes Measurement Information System (PROMIS) adult physical functioning item bank.
        Arch Phys Med Rehabil. 2013; 94: 2291-2296
        • Bruce B.
        • Fries J.
        • Lingala B.
        • Hussain Y.N.
        • Krishnan E.
        Development and assessment of floor and ceiling items for the PROMIS physical function item bank.
        Arthritis Res Ther. 2013; 15: R144
        • Menendez M.E.
        • Bot A.G.
        • Hageman M.G.
        • Neuhaus V.
        • Mudgal C.S.
        • Ring D.
        Computerized adaptive testing of psychological factors: relation to upper-extremity disability.
        J Bone Joint Surg Am. 2013; 95: e149
        • Morgan J.H.
        • Kallen M.A.
        • Okike K.
        • Lee O.C.
        • Vrahas M.S.
        PROMIS physical function computer adaptive test compared with other upper extremity outcome measures in the evaluation of proximal humerus fractures in patients older than 60 years.
        J Orthop Trauma. 2015; 29: 257-263
        • Kortlever J.T.
        • Janssen S.J.
        • van Berckel M.M.
        • Ring D.
        • Vranceanu A.M.
        What is the most useful questionnaire for measurement of coping strategies in response to nociception?.
        Clin Orthop Relat Res. 2015; 473: 3511-3518
        • Hays R.D.
        • Spritzer K.L.
        • Fries J.F.
        • Krishnan E.
        Responsiveness and minimally important difference for the Patient-Reported Outcomes Measurement Information System (PROMIS) 20-item physical functioning short form in a prospective observational study of rheumatoid arthritis.
        Ann Rheum Dis. 2015; 74: 104-107
        • Hung M.
        • Stuart A.R.
        • Higgins T.F.
        • Saltzman C.L.
        • Kubiak E.N.
        Computerized adaptive testing using the PROMIS physical function item bank reduces test burden with less ceiling effects compared to the short musculoskeletal function assessment in orthopaedic trauma patients.
        J Orthop Trauma. 2014; 28: 439-443
        • Doring A.C.
        • Nota S.P.
        • Hageman M.G.
        • Ring D.C.
        Measurement of upper extremity disability using the Patient-Reported Outcomes Measurement Information System.
        J Hand Surg Am. 2014; 39: 1160-1165
        • Fries J.
        • Rose M.
        • Krishnan E.
        The PROMIS of better outcome assessment: responsiveness, floor and ceiling effects, and Internet administration.
        J Rheumatol. 2011; 38: 1759-1764
        • Haase S.C.
        • Chung K.C.
        Management of malunions of the distal radius.
        Hand Clin. 2012; 28: 207-216
        • Curtin C.M.
        • Hernandez-Boussard T.
        Readmissions after treatment of distal radius fractures.
        J Hand Surg Am. 2014; 39: 1926-1932
        • Cook K.F.
        • Dunn W.
        • Griffith J.W.
        • et al.
        Pain assessment using the NIH Toolbox.
        Neurology. 2013; 80: S49-S53
        • Amtmann D.
        • Cook K.F.
        • Jensen M.P.
        • et al.
        Development of a PROMIS item bank to measure pain interference.
        Pain. 2010; 150: 173-182
        • Lutz K.
        • Yeoh K.M.
        • MacDermid J.C.
        • Symonette C.
        • Grewal R.
        Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older.
        J Hand Surg Am. 2014; 39: 1280-1286
        • Navarro C.M.
        • Pettersson H.J.
        • Enocson A.
        Complications after distal radius fracture surgery: results from a Swedish nationwide registry study.
        J Orthop Trauma. 2015; 29: e36-e42
        • McKay S.D.
        • MacDermid J.C.
        • Roth J.H.
        • Richards R.S.
        Assessment of complications of distal radius fractures and development of a complication checklist.
        J Hand Surg Am. 2001; 26: 916-922
        • Mathews A.L.
        • Chung K.C.
        Management of complications of distal radius fractures.
        Hand Clin. 2015; 31: 205-215
        • Griffin J.W.
        • Chhabra A.B.
        Complications after volar plating of distal radius fractures.
        J Hand Surg Am. 2014; 39: 1183-1185
        • Bansback N.
        • Hole A.R.
        • Mulhern B.
        • Tsuchiya A.
        Testing a discrete choice experiment including duration to value health states for large descriptive systems: addressing design and sampling issues.
        Soc Sci Med. 2014; 114: 38-48
        • Dy C.J.
        • Jang E.
        • Taylor S.A.
        • Meyers K.N.
        • Wolfe S.W.
        The impact of coronal alignment on distal radioulnar joint stability following distal radius fracture.
        J Hand Surg Am. 2014; 39: 1264-1272
        • Lalone E.A.
        • Rajgopal V.
        • Roth J.
        • Grewal R.
        • MacDermid J.C.
        A cohort study of one-year functional and radiographic outcomes following intra-articular distal radius fractures.
        Hand (NY). 2014; 9: 237-243
        • Grewal R.
        • MacDermid J.C.
        • King G.J.
        • Faber K.J.
        Open reduction internal fixation versus percutaneous pinning with external fixation of distal radius fractures: a prospective, randomized clinical trial.
        J Hand Surg Am. 2011; 36: 1899-1906
        • Rozental T.D.
        • Blazar P.E.
        • Franko O.I.
        • Chacko A.T.
        • Earp B.E.
        • Day C.S.
        Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation: a prospective randomized trial.
        J Bone Joint Surg Am. 2009; 91: 1837-1846
        • Teunis T.
        • Bot A.G.
        • Thornton E.R.
        • Ring D.
        Catastrophic thinking is associated with finger stiffness after distal radius fracture surgery.
        J Orthop Trauma. 2015; 29: e414-e420
        • Calfee R.P.
        • Shah C.M.
        • Canham C.D.
        • Wong A.H.
        • Gelberman R.H.
        • Goldfarb C.A.
        The influence of insurance status on access to and utilization of a tertiary hand surgery referral center.
        J Bone Joint Surg. 2012; 94: 2177-2184
        • Walsh M.
        • Davidovitch R.I.
        • Egol K.A.
        Ethnic disparities in recovery following distal radial fracture.
        J Bone Joint Surg Am. 2010; 92: 1082-1087
        • Andersen D.J.
        • Blair W.F.
        • Steyers Jr., C.M.
        • Adams B.D.
        • el-Khouri G.Y.
        • Brandser E.A.
        Classification of distal radius fractures: an analysis of interobserver reliability and intraobserver reproducibility.
        J Hand Surg Am. 1996; 21: 574-582
        • Kreder H.J.
        • Hanel D.P.
        • McKee M.
        • Jupiter J.
        • McGillivary G.
        • Swiontkowski M.F.
        Consistency of AO fracture classification for the distal radius.
        J Bone Joint Surg Br. 1996; 78: 726-731
        • Paksima N.
        • Pahk B.
        • Romo S.
        • Egol K.A.
        The association of education level on outcome after distal radius fracture.
        Hand (NY). 2014; 9: 75-79
        • Bot A.G.
        • Mulders M.A.
        • Fostvedt S.
        • Ring D.
        Determinants of grip strength in healthy subjects compared to that in patients recovering from a distal radius fracture.
        J Hand Surg Am. 2012; 37: 1874-1880

      Linked Article