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

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.