Functional outcome and management pathways for adult patients presenting to an Australian health service with distal radius fracture.

OBJECTIVE

Primarily to determine mid-term functional outcome for patients with distal radius fracture (DRF) and to compare this between operative and conservatively managed patients. Secondarily to examine for differences in age, gender and number of instability factors between management groups.

METHODS

Eligible patients (age 18 years or more, closed DRF managed to completion of care within Monash Health), presenting between 1 January and 31 December 2016. Completion of the patient-rated wrist evaluation (PRWE) questionnaire was sought at 6-12 months post-injury. Management was noted (operative or conservative). Age, sex and number of defined instability factors present (dorsal angulation >20°, intra-articular fracture, associated ulna fracture, dorsal comminution, radial shortening >2 mm) are reported and compared between management groups.

RESULTS

Of 369 eligible patients, 199 (54%) completed a PRWE. Median age was 60 years (interquartile range [IQR] 45-71), 150 (75%) were women, median number of instability factors present was 2 (IQR 1-4) and 45 (23%) underwent operative management. Difference in PRWE scores between operative and conservatively managed patients was not significant (20 [IQR 7-36] vs 16 [IQR 5-35]). Differences in age and gender between management groups were not significant. Significantly more in the operative group had presence of four or more instability factors (44% [95% confidence interval 30-60] vs 20% [14-27]).

CONCLUSION

The mid-term median PRWE score was 18 (IQR 5-36). This was not significantly different between operative and conservatively managed patients. Operation was more likely when four or more instability factors were present.