Factors Associated With Mid-term PROMIS Upper Extremity Scores in Conservatively and Operatively Treated Distal Radius Fractures

Abstract

Background:

While radiographic outcomes after distal radius fractures (DRFs) are emphasized in clinical guidelines, several studies demonstrated that radiographic measures do not correlate with patient-reported outcomes (PROs), especially in patients aged ≥65 years. This study aims to determine whether fracture severity and radiographic parameters following fracture healing are prognostic of PROs, hypothesizing no strong association exists between these factors.

Methods:

This study retrospectively reviewed prospectively collected Patient-Reported Outcomes Measurement Information System Upper Extremity Function (PROMIS UE) scores in patients sustaining acute DRF between January 2016 and January 2023 with a 6-month minimum follow-up. Independent variables were patient demographics, comorbidities, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) fracture classification, and radiographic parameters following treatment. Multivariate linear regression analyzed associations between nonradiographic and radiographic parameters and PROMIS UE score. We performed subanalyses of patients treated operatively and nonoperatively and patients above and below the cohort’s median age.

Results:

In total, 385 patients were included, of which 193 were treated conservatively and 192 operatively. Multivariate analysis demonstrated no association of PROMIS UE score with AO/OTA fracture classification, ulnar variance, volar tilt, or radial inclination at 6 months. A subanalysis of patients aged ≤62 years showed that every degree increase in radial inclination was associated with 0.3-point decrease in PROMIS UE.

Conclusions:

This study found no robust relationship between patient-reported function and radiographic outcomes following DRF. Initial fracture severity, similarly, did not predict mid-term patient-reported function. Our findings support prior evidence that achieving reduction within the established range of radiographic parameters is sufficient for patient function.

Level of Evidence:

3, prognostic retrospective cohort study.

Keywords

patient-reported outcomes distal radius fracture volar tilt ulnar variance radial inclination

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References

Davis

Chung

. Chapter 2 – Epidemiology of distal radius fractures. In: Jupiter

Chammas

, eds. Distal Radius Fractures. Elsevier; 2021:13-19.

Kakar

Noureldin

Van Houten

, et al. Trends in the incidence and treatment of distal radius fractures in the United States in privately insured and Medicare advantage enrollees. Hand (N Y). 2022;17(2):331-338.

Alsubheen

MacDermid

Walton

, et al. The effect of diabetes on functional outcomes among individuals with distal radial fractures. J Hand Ther. 2019;32(4):476-482. doi:10.1016/j.jht.2018.02.008

Hall

Ostergaard

Dowlatshahi

, et al. The impact of obesity and smoking on outcomes after volar plate fixation of distal radius fractures. J Hand Surg Am. 2019;44(12):1037-1049. doi:10.1016/j.jhsa.2019.08.017

Chung

Kim

Malay

, et al. Predicting outcomes after distal radius fracture: a 24-center international clinical trial of older adults. J Hand Surg Am. 2019;44(9):762-771. doi:10.1016/j.jhsa.2019.05.016

Jayakumar

Teunis

Vranceanu

, et al. Early psychological and social factors explain the recovery trajectory after distal radial fracture. J Bone Joint Surg Am. 2020;102(9):788-795. doi:10.2106/JBJS.19.00100

Goudie

Broll

Warwick

, et al. The association between psychological factors and outcomes after distal radius fracture. J Hand Surg Am. 2022;47(2):190.e1-190. doi:10.1016/j.jhsa.2021.04.012

Wilson

Holzgrefe

Staley

, et al. Use of a 5-Item Modified Frailty Index for risk stratification in patients undergoing surgical management of distal radius fractures. J Hand Surg Am. 2018;43(8):701-709. doi:10.1016/j.jhsa.2018.05.029

Marsh

Slongo

Agel

, et al. Fracture and dislocation classification compendium 2007. J Orthop Trauma. 2007;21(suppl 10):S1-133.

10.

Mann

Wilson

Gilula

LA.

Radiographic evaluation of the wrist: what does the hand surgeon want to know. Radiology. 1992;184(1):15-24.

11.

Kaat

Buckenmaier

III Cook

, et al. The expansion and validation of a new upper extremity item bank for the Patient-reported Outcomes Measurement Information System(R) (PROMIS). J Patient Rep Outcomes. 2019;3(1):69. doi:10.1186/s41687-019-0158-6

12.

Management of distal radius fractures evidence-based clinical practice guideline; December 5, 2020. Accessed September 5, 2025. www.aaos.org/drfcpg

13.

Döring

Nota

Hageman

, et al. Measurement of upper extremity disability using the patient-reported outcomes measurement information system. J Hand Surg Am. 2014;39(6):1160-1165. doi:10.1016/j.jhsa.2014.03.013

14.

Hollenberg

Mao

Hammert

WC.

Outcomes following surgical treatment of distal radial fracture: a comparison of older and younger patients using PROMIS. J Hand Surg Eur Vol. 2022;47(6):590-596. doi:10.1177/17531934211070218

15.

Kazmers

Qiu

Yoo

, et al. Establishing the minimal clinically important difference for the PROMIS upper extremity computer adaptive test version 2.0 in a nonshoulder hand and upper extremity population. J Hand Surg Am. 2021;46(10):927.e1-927. doi:10.1016/j.jhsa.2021.01.023

16.

Chung

Kotsis

Kim

HM.

Predictors of functional outcomes after surgical treatment of distal radius fractures. J Hand Surg Am. 2007;32(1):76-83. doi:10.1016/j.jhsa.2006.10.010

17.

Dario

Matteo

Carolina

, et al. Is it really necessary to restore radial anatomic parameters after distal radius fractures? Injury. 2014;45(suppl 6):S21-26. doi:10.1016/j.injury.2014.10.018

18.

Grewal

MacDermid

Pope

, et al. Baseline predictors of pain and disability one year following extra-articular distal radius fractures. Hand (N Y). 2007;2(3):104-111. doi:10.1007/s11552-007-9030-x

19.

Grewal

MacDermid

JC.

The risk of adverse outcomes in extra-articular distal radius fractures is increased with malalignment in patients of all ages but mitigated in older patients. J Hand Surg Am. 2007;32(7):962-970. doi:10.1016/j.jhsa.2007.05.009

20.

Schmidt

Gordon

Tagil

, et al. Association between radiographic and clinical outcomes following distal radial fractures: a prospective cohort study with 1-year follow-up in 366 patients. J Bone Joint Surg Am. 2023;105(15):1156-1167. doi:10.2106/JBJS.22.01096

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