Anxiety and the Attainment of Clinically Significant Outcomes in Operatively Treated Distal Radius Fracture Patients: A Retrospective Study of 78 Patients

Abstract

Background:

Distal radius fractures (DRFs) are a common orthopedic injury. Patient-reported outcomes (PROs) and achievement of the minimum clinically important difference (MCID) provide insight into functional recovery. The purpose of this study was to evaluate the impact of patient characteristics, particularly anxiety, on PROs and MCID achievement following DRF.

Methods:

All adult patients undergoing primary operative fixation of a DRF at a single health system between 2018 and 2023 were identified. Exclusions included polytrauma, fixation besides a volar locking plate, or missing PROs at baseline or any postoperative follow-up. The Patient-Rated Wrist Evaluation (PRWE) was collected preoperatively and at 6 weeks, 3 months, and 6 months postoperatively. An anchor-based MCID was calculated using a general health question.

Results:

Seventy-eight patients were included (87.2% female, average age 62.4 ± 12.5 years). Fifty-nine patients (75.6%) had intraarticular fractures. Depression was more common in the anxiety cohort (68.4% vs 20.3%, P < .001). The MCID thresholds at 3 and 6 months were 57.7 and 61.8, respectively. Patients with anxiety had lower MCID achievement at 6 months (31.6% vs 59.3%, P = .035) and smaller PRWE improvements (P = .002). The PRWE scores at 6 weeks and 3 months were moderately correlated with 6-month scores (r = .51, r = .58, respectively), and 3-month changes were strongly correlated with 6-month changes (r = .73)

Conclusions:

Anxiety was associated with smaller improvements in PRWE scores and reduced MCID achievement, highlighting the importance of addressing mental health in postoperative care. Early PRWE scores were moderately predictive of 6-month scores, suggesting that patients with limited early improvement may benefit from targeted interventions to optimize long-term recovery.