Fractures of the Distal Radius - Incidence, treatment and outcome

ABSTRACT Fractures of the distal radius are common injuries that may cause persistent disability and pain. This thesis prospectively investigates the incidence and characteristics of distal radius fractures, the relationship between fracture malunion and disability and the natural course of patient-reported outcome after fracture in a well-defined population in Northeastern Scania, Sweden. Furthermore, it compares two surgical treatment methods in a randomized, assessor-blinded design. The DASH questionnaire was used to measure patient-reported disability and radiographs, grip strength and wrist range of motion were used to measure clinical outcomes. The data were analyzed using descriptive statistics and multiple regression and mixed model analyses. The annual incidence of distal radius fractures was 26 per 10,000 adults. The annual incidence among patients of working age was 13.4 per 10,000. The incidence rose with age among both men and women. Displaced fractures and complete articular (AO type C) fractures were more common among persons those 80 or older, than among younger people. The method of non-bridging external fixation had no relevant clinical advantage over wrist-bridging external fixation in treating elderly patients with moderately or severely displaced distal radius fractures, although non-bridging fixation was somewhat more effective in maintaining radial length. Patients with distal radius fracture that healed with malunion, defined as dorsal tilt exceeding 10° and/or positive ulnar variance, had greater arm-related disability and weaker grip strength one year after the injury, regardless of age. Patients with fracture malunion had greater disability and slower improvement in disability from baseline up to two years after the fracture compared to patients with no malunion. Ulnar variance was the most important radiographic variable in relation to persistent disability up to two years after the fracture. Following a distal radius fracture, postmenopausal women had less wrist pain and improved grip strength and wrist range of motion beyond one year and up to 2-4 years after fracture. In addition, patients with fractures that healed with moderate or severe malunion had more disability and pain at one year, but showed a more pronounced improvement up to 2-4 years than patients with no or less severe malunion. These findings can be used to improve the treatment of distal radius fractures to prevent persistent disability and pain, which commonly affects postmenopausal women with an active lifestyle