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Title: Long - term outcomes and quality of life after distal radius fractures depending on the treatment method
Abstract:
Introduction: Distal radius fractures (DRF) are one of the most common fractures with growing incidence in developed countries. DRF are a reliable predictor of another osteoporotic fracture. Data concerning DRF mortality are conflicting and vague. Usefulness of common DRF classification systems in predicting mortality is unexplored. Distal radius fractures can be treated either by operative or nonoperative techniques. Appropriate management of DRF is essential due to possible long-term complications including physical activity limitations and chronic pain. Numerous studies suggest that operative treatment with anatomic reduction and restoration of radiographic parameters leads to better functional outcomes and better quality of life than nonsurgical treatment. Methods: We identified all patients hospitalized between January 1st 2008 and May 30th 2015 with isolated distal radius fracture. After confirmation of fracture, we collected the following data: age, sex, hand side, residency. Fractures were evaluated according to AO, Frykman and Fernandez classifications. The censoring date of follow-up was 31 May 2016. In the first part of the study, patients with isolated distal radius fracture aged ≥ 50 years were included. Cumulative mortality was assessed 3, 6, 9 months and 1 year after distal radius fracture, and analyzed within sex groups. We calculated crude and standardized mor ; tality ratios (SMRs). Mortality ratios and long-term survival analysis with Kaplan-Meier estimator and log-rank tests with univariate and multivariate Cox proportional hazards model were used. In the second part of the study from 1774 identified eligible participants with isolated DRF aged ≥ 18 years divided into operative and nonoperative groups we have randomly chosen 240 patients: 120 treated surgically and 120 nonsurgically who were contacted via phone or mail. Of approached 240 patients, 29 patients declined to enter the study, 4 were deceased. Observation period was at least 1 year after DRF. All participants gave written informed consent. Each participant fulfilled questionnaire including data on inter alia: age at the time of trauma, sex, hand side of fracture, hand dominance, energy of injury, education, smoking, work status, time of medical leave. Prereduction, post reduction and study final radiographs were assessed. Fractures were classified using AO classification. During an appointment standard radiographs of fractured and contralateral side were taken. Radiographic parameters such as radial length, ulnar variance, volar tilt, teardrop angle (TDA), anteroposterior distance (APD) were assessed. Radiographic outcomes were based on final patient x- ray. Orthopedic examination of both upper extremities was performed. Hand grip and pinch strength data were collected. ; Additionally, to evaluate long-term functional outcomes we used following tools: Patient Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder and Hand (DASH), Nine Hole Peg Test (9-HPT). Quality of life assessment was conducted using Short Form Health Survey (SF-36) and International Osteoporosis Foundation Quality of Life Questionnaire (IOF QLQ). Results: We enrolled 1308 consecutive patients to the first part of the study. The average age of the entire cohort was 72.5 ± 12 years. The study group consisted of 256 men (19.6%) with mean age 66 ± 12 y/o and 1052 women (80.4%) with mean age 74 ± 12 y/o. Men were statistically younger at the time of the fracture than women (p<0.0001). After 1-year of follow up the overall study group mortality ratio was 4.5%, comparing between genders: 2.2 - fold higher in men. In long-term survival analysis, excess men mortality remained significant. Factors associated with higher mortality at any point of the study were: age (HR: 1.08, 95%CI: 1.07–1.10, p<0.000001), male sex (HR: 1.92, 95%CI: 1.34-2.77; p<0.001), AO type A (HR: 1.64 95%CI 1.19-2.25, p<0.01) and Frykman type I (HR: 2.12 95%CI: 1.36-3.29, p<0.001). To the second part of the study we randomly enrolled 207 patients with distal radius fractures: 101 treated operatively, 106 treated nonoperatively. Mean age of entire cohort was 64 ± 17.9 years. Women comprised of 150 (72. ; 5%), men 57 (27.5 %); mean observation time was 3.9 ± 1.6 years; ranged from minimum 1.1 to 8.1 years. There were no significant differences in analyzed operative an nonoperative cohorts in age, sex, hand dominancy, trauma energy, smoking, comorbidities and education or AO fracture types distribution. Nonoperative cohort had higher ratios of unemployed and retired patients compared to the operative group. Operative cohort consisted of 87 subjects (86.1%) who underwent open reduction and volar plating, and 14 patients treated by percutaneus pinning and cast (13.9 %). Nonoperative cohort was treated by closed reduction and short arm cast. We found higher rates of malunion in nonoperative group (p<0.0001) and worse radiologic parameters such as volar tilt (p<0.0001), teardrop angle (p<0.0001) versus operative cohort. Nevertheless radiological parameters were not correlated with DASH and PRWE results. Moreover, patients aged 50 years and above treated operatively had similar functional outcomes (DASH, PRWE) to those treated nonoperatively. Similarly quality of life in operatively treated distal radius fracture patients was better than amongst those treated nonsurgically. However, after subdivision of cohorts we observed no such differences regardless of treatment method in patients aged ≥ 50 years. SF-36 and IOF QLQ scores were correlated with DASH and PRWE results. Conclusions: ; 1. Distal radius fractures are connected with premature mortality. Men have higher mortality compared with women following distal radius fracture in population aged 50 years or above. 2. Extra articular fractures classified as AO type A or Frykman type I may be predictors of higher mortality in distal radius fracture population aged 50 years or above. 3. Long-term functional outcomes after distal radius fractures in patients aged 50 years and older are comparable, regardless of the treatment method. Surgical treatment in patients aged less than 50 years is associated with better radiological and functional outcomes. Pain syndrome and arthritis were the most frequently recorded long-term complications of distal radius fracture. 4. Quality of life in patients with distal radius fracture aged 50 years and above is comparable regardless of treatment method. Surgical treatment of distal radius fractures results in better quality of life in patients less than 50 years old.
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Rada Dyscypliny Nauki medyczne
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Apr 8, 2024
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Mar 29, 2022
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http://dl.cm-uj.krakow.pl:8080/publication/4577
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| Edition name | Date |
|---|---|
| ZB-134100 | Apr 8, 2024 |
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