Distal radius fractures : a risk throughout life

Abstract

Treating distal radius fractures (DRFs) is routine in most orthopedic clinics. Most fractures are treated non-operatively but, in some cases, surgery is needed to restore function. There are still controversies regarding the indications for surgical treatment and the surgical methods. The benefit of surgery with volar locking plates is mainly questioned regarding older adults. Most patients treated for DRFs regain good function, but a few will suffer consequences years to come.

In Study I the Swedish national patient register (SNPR) was validated regarding the codes corresponding with a DRF (S52.5 and S52.6). 1 430 medical charts were reviewed, and a correct diagnosis was confirmed or dismissed. Positive predictive value (PPV) ranged from 92% to 100%.

Study II was a nationwide observational study using register data from the SNPR. During the study period 2005-2013, 90 970 fractures were identified. Incidence rates were calculated in groups based on age and sex. Boys aged 10-14 years had the highest incidence rate. There was seasonal variation in incidence rate, and it peaked in May and September. The overall incidence was higher in the beginning of the study period.

Study III was a three-year follow-up of a RCT in which non-operative treatment and surgery with a volar locking plate were compared in patients ≥70 years with a displaced DRF. The median Patient Rated Wrist Evaluation (PRWE) was lower, indicating less disability, among the surgically treated compared to the non-operative treated (p=0.027). The clinical significance of the 9 points difference is, however, questionable. Study IV was a qualitative interview study where the data was analyzed by using content analysis. Patients included had suffered from impairment despite a radiologically benign DRFs. Three categories were derived in the analysis; 1. Persistent impairment and how it affects life, 2. Being a patient and 3. Personal circumstances affecting the experience. The first category illustrated the struggle with daily life activities, pain, and anxiety while the second category described the feelings in the unfamiliar setting of being injured, having to trust others and figure out a perceived hard to navigate health care system. In the last category, aspects in life and personality were highlighted. The impairment after a DRF can be difficult to measure and the experience during treatment and rehabilitation can be important for the perceived recovery.

In conclusion, the SNPR is valid for epidemiological studies of distal radius fractures. Distal radius fractures in the pediatric population seem to be diminishing. Patients over the age 70 with a DRF may benefit from surgical treatment. Measuring the impairment after a DRF can be challenging and the perceived outcome can be affected by the experience during treatment and recovery.