Baseline Predictors of Pain and Disability One Year following Extra-Articular Distal Radius Fractures

Abstract

Distal radius fractures are common injuries; however, identifying which factors are responsible for predicting outcomes remains an area of controversy. The purpose of this study was to define factors predictive of patient-reported pain and disability at 1 year in a prospective cohort of extra-articular distal radius fractures (n=222). Data were collected at the initial visit and after 3, 6, and 12 months. The primary outcome was the 1-year patient-rated wrist evaluation (PRWE) score. The effect of baseline patient and injury characteristics on the 1-year PRWE score was assessed. Univariate and forward stepwise regression analyses both agreed that the most influential predictor of pain and disability at 1 year was injury compensation. The 1-year PRWE score was significantly higher for subjects involved with third-party claims (35.48) compared to those that were not involved in any claims (14.97), p=0.006. The regression model found that three baseline factors – injury compensation, education, and other medical comorbidities – explained 16.4% of the variance in PRWE scores at 1 year. No injury characteristic, including the degree of initial fracture displacement, was found to significantly influence the 1-year PRWE score. This study has shown that baseline patient and injury characteristics play a small role in predicting 1-year patient-reported pain and disability in extra-articular distal radius fractures. Conceptual factors outside of this biomedical model should be investigated.

Keywords

Wrist Fracture Outcome Pain Disability

Get full access to this article

View all access options for this article.

References

1 Altissimi

Antenucci

Fiacca

Mancini

. Long term results of conservative treatment of fractures of the distal radius. Clin Orthop 1986;206:202–10.

2 Bradway

Amadio

Cooney

. Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius. J Bone Joint Surg Am 1989;71:839–47.

3 Filan

. The effect of workers' or third-party compensation on return to work after hand surgery. Med J Aust 1996;165 (2):80–2.

4 Gartland

Werley

. Evaluation of healed Colles' fractures. J Bone Joint Surg Am 1951;33A:895–907.

5 Hollevoet

Verdonk

. Outcome of distal radius fractures in relation to bone mineral density. Acta Orthop Belg 2003;69 (6):510–4.

6 MacDermid

. Development of a scale for patient rating of wrist pain and disability. J Hand Ther 1996;9:178–83.

7 MacDermid

Turgeon

Richards

Beadle

Roth

. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998;12:577–86.

8 MacDermid

Richards

Donner

Bellamy

Roth

. 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;25:330–40.

9 MacDermid

Donner

Richards

Roth

. Patient versus injury factors as predictors of pain and disability six months after a distal radius fracture. J Clin Epidemiol 2002;55(9):849–54.

10.

10 Owen

Melton

Johnson

Ilstrup

Riggs

. Incidence of Colles' fracture in a North American community. J Bone Joint Surg 1982;72:605–7.

11.

11 Porter

Stockley

. Fractures of the distal radius intermediate and end results in relation to radiologic parameters. Clin Orthop 1987;220:241–52.

12.

12 Stewart

Innes

Burke

. Factors affecting the outcome of Colles' fracture: an anatomical and functional study. Injury 1985;16(5):289–95.

13.

13 Trumble

Wagner

Hanel

Vedder

Gilbert

. Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation. J Hand Surg [Am] 1998;23:381–94.

14.

14 Wakefield

McQueen

. The role of physiotherapy and clinical predictors of outcome after fracture of the distal radius. J Bone Joint Surg Br 2000;82:972–6.