Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures

• Published in: The Journal of hand surgery (American ed.) Vol. 29; no. 6; pp. 1121 - 1127
• Main Authors: Anzarut, Alexander, Johnson, Jeffrey A., Rowe, Brian H., Lambert, Robert G.W., Blitz, Sandra, Majumdar, Sumit R.
• Format: Journal Article
• Language: English
• Published: New york, NY Elsevier Inc 01-11-2004; Elsevier; Elsevier Science Ltd
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cohort Studies; Diseases of the osteoarticular system; Distal radius (wrist) fractures; elderly patients; Emergency Service, Hospital; Female; Follow-Up Studies; Fracture Healing - physiology; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Middle Aged; Outcome Assessment (Health Care); outcomes; Patient Satisfaction; Postoperative Complications - diagnostic imaging; Pronation - physiology; Prospective Studies; radiographic reduction; Radiography; Radius Fractures - diagnostic imaging; Radius Fractures - therapy; Range of Motion, Articular - physiology; satisfaction; Supination - physiology; Traumas. Diseases due to physical agents; Wrist Injuries - diagnostic imaging; Wrist Injuries - therapy; Distal radius (wrist) fractures; elderly patients; radiographic reduction; satisfaction; outcomes; Radius; Prognosis; Diseases of the osteoarticular system; Fracture; Urban area; Emergency department; Cohort study; Age; Human; satifaction; Urban environment; Radiodiagnosis; Exploration; Method; Trauma; Standards; Case study; Radiography; Treatment; Distal; Tilt; Elderly
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2004.07.002

There have been few prospective studies of elderly patients with conservatively treated distal radius fractures and little is known about the relationship between acceptable radiographic reduction and functional outcomes in this population. We hypothesized that acceptable fracture reduction (according to standard radiographic dorsal/volar tilt criteria) would be associated with better functional outcomes and greater satisfaction.
Seventy-four patients who were at least 50 years of age with conservatively managed distal radius fractures were recruited from 2 large urban emergency departments from January 2001 to December 2001. Patients with wrist fractures treated in the emergency department and discharged home were included; patients admitted to the hospital or who required surgical reduction were excluded. Standard lateral radiographs were taken after the final cast was removed. These were reviewed independently by a reference-standard musculoskeletal radiologist and the degree of dorsal/volar tilt was recorded. This value was dichotomized according to standard published dorsal/volar tilt criteria as acceptable (dorsal tilt <10° or volar tilt <20°) or unacceptable (dorsal tilt >10° or volar tilt >20°). The Medical Outcomes Study Short-Form 12 (SF-12); the Disabilities of the Arm, Shoulder, and Hand questionnaire; and a patient satisfaction survey were used to assess patient-reported outcomes 6 months after the injury.
The average dorsal/volar tilt measured by the reference standard radiologist was 3.4° (SD = 13.6) dorsal; overall 47 patients (64%) were considered to have an acceptable radiographic reduction. Acceptable radiographic reduction was not associated with better generic physical or mental health status, lesser degrees of upper-extremity disability, or greater satisfaction with outcomes than was unacceptable reduction. Overall 44 of 74 patients (59%) reported being satisfied or very satisfied with their functional status at 6 months.
Contrary to our hypotheses we found that acceptable radiographic reduction (according to dorsal/volar tilt criteria) was not associated with better self-reported functional outcomes or increased satisfaction at 6 months in elderly patients with conservatively treated distal radius fractures.