Purpose
Most patients recover well from a distal radius fracture (DRF). However, approximately
one-fifth have severe disability after 1 year when evaluated using the Disabilities
of the Arm, Shoulder, and Hand (DASH) questionnaire. In the present study, we evaluated
this subgroup of patients in our register with an inferior outcome. We hypothesized
that the patient-reported outcome would improve with time.
Methods
Since 2001, patients 18 years and older with a DRF, at the Department of Orthopedics,
Skåne University Hospital (Lund, Sweden) are prospectively registered in the Lund
Wrist Fracture Register. We have previously defined a DASH score above 35 at the 1-year
follow-up as the cutoff of major disability. Between 2003 and 2012, 17% of the patients
(445 of 2,571) in the register exceeded this cutoff. Three hundred eighty-eight were
women and 57 men and the mean age was 69 years (range, 18–95 years). One-fourth had
been surgically treated. In December 2014, 2 to 12 years after the fracture, a follow-up
DASH questionnaire was sent to the 346 of 445 patients still alive.
Results
Seventy-three patients (27%) had initially been treated surgically and 196 (73%) nonsurgically
for their DRF. Two hundred sixty-nine of 346 patients (78%) returned the follow-up
DASH questionnaire at 2 to 12 years (mean, 5.5 years) after the fracture. The overall
median DASH score improved from 50 at 1 year to 36 at the 2- to 12-year follow-up,
(P < .05). Forty-seven percent had improved to a score below the cutoff 35, but 53%
remained at a high suboptimal level.
Conclusions
The subjective outcome after a DRF improves over time for patients with an inferior
result at 1 year, but more than half of the patients continue to have major disability.
Type of study/level of evidence
Prognostic II.
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 accessOne-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:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology of adult fractures: a review.Injury. 2006; 37: 691-697
- The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study.Bone Joint J. 2014; 96: 963-969
- Incidence and characteristics of distal radius fractures in a southern Swedish region.BMC Musculoskelet Disord. 2007; 8: 48
- The 21st-century landscape of adult fractures: cohort study of a complete adult regional population.J Bone Miner Res. 2015; 30: 535-542
- Epidemiology and treatment of distal radius fractures in Reykjavik, Iceland, in 2004: comparison with an Icelandic study from 1985.Acta Orthop. 2011; 82: 494-498
Statistics Sweden, Demographic Reports, The Future Population of Sweden 2006–2050. Available at: http://www.scb.se/statistik/_publikationer/BE0401_2006I50_BR_BE51BR0602ENG.pdf. Accessed Feburary 26, 2018.
- Trends in the United States in the treatment of distal radial fractures in the elderly.J Bone Joint Surg Am. 2009; 91: 1868-1873
- Significant change in the surgical treatment of distal radius fractures: a nationwide study between 1998 and 2008 in Finland.J Trauma. 2011; 71: 939-943
- Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004–2010.Acta Orthop. 2013; 84: 292-296
- Epidemiology and health-care utilisation of wrist fractures in older adults in The Netherlands, 1997–2009.Injury. 2013; 44: 421-426
- Pain and disability reported in the year following a distal radius fracture: a cohort study.BMC Musculoskelet Disord. 2003; 4: 24
- Similar 1-year subjective outcome after a distal radius fracture during the 10-year-period 2003–2012: a longitudinal register-based study involving 3,666 patients.Acta Ortop. 2017; 88: 451-456
- Evaluation of a treatment protocol in distal radius fractures.Acta Ortop. 2008; 79: 376-385
- Development of an upper extremity outcome measure: the DASH.Am J Ind Med. 1996; 29: 602-608
- The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: reliability and validity of the Swedish version evaluated in 176 patients.Acta Ortop. 2000; 71: 613-618
- Development of the QuickDASH: comparison of three item-reduction approaches.J Bone Joint Surg Am. 2005; 87: 1038-1046
- The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH.BMC Musculoskeletal Disord. 2006; 7: 44
- Correlation of DASH and QuickDASH with measures of psychological distress.J Hand Surg Am. 2009; 34: 1499-1505
- The DASH and the QuickDASH instruments. Normative values in the general population in Norway.J Hand Surg Eur. 2014; 39: 140-144
- Minimal clinically important differences of 3 patient-rated outcomes instruments.J Hand Surg Am. 2013; 38: 641-649
- External or internal fixation in the treatment of non-reducible distal radial fractures? A 5-year follow-up of a randomized study involving 50 patients.Acta Orthop. 2011; 82: 610-613
- Operative management of distal radial fractures with 2.4-millimeter locking plates.J Bone Joint Surg Am. 2009; 91: 55-65
- Distal radius malunion increases risk of persistent disability 2 years after fracture: a prospective cohort study.Clin Orthop Relat Res. 2013; 471: 1691-1697
- The relationship between displacement and clinical outcome after distal radius (Colles’) fracture.J Hand Surg Eur. 2012; 38: 116-126
- Fractures of the distal end of the radius in young adults: a 30-year follow-up.J Hand Surg Br. 1993; 18: 45-49
- The American Academy of Orthopaedic Surgeons outcomes instruments.J Bone Joint Surg Am. 2002; 84: 208-215
Institute for Work & Health. The DASH and QuickDASH—e-bulletin summer 2013. Available at: http://www.dash.iwh.on.ca/sites/dash/files/dash_e-bulletin_2013_summer.pdf. Accessed Feburary 26, 2018.
- Osteotomy of dorsally displaced malunited fractures of the distal radius: no loss of radiographic correction during healing with a minimally invasive fixation technique and an injectable bone substitute.Acta Ortop. 2008; 79: 262-268
- Osteotomy of distal radius fracture malunion using a fast remodeling bone substitute consisting of calcium sulphate and calcium phosphate.J Biomed Mater Res B Appl Biomater. 2010; 92: 281-286
- Mid-term functional outcome after the internal fixation of distal radius fractures.J Orthop Surg Res. 2012; 7: 4
Article info
Publication history
Published online: November 27, 2018
Accepted:
October 16,
2018
Received:
February 27,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
