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Intermediate-Term Outcome After Distal Radius Fracture in Patients With Poor Outcome at 1 Year : A Register Study With a 2- to 12-Year Follow-Up

Landgren, Marcus LU ; Teurneau, Vendela; Abramo, Antonio LU ; Geijer, Mats LU and Tägil, Magnus LU (2019) In Journal of Hand Surgery 44(1). p.39-45
Abstract

Purpose: Most patients recover well from a distal radius fracture (DRF). However, approximately one-fifth have severe disability after 1 year when evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. In the present study, we evaluated this subgroup of patients in our register with an inferior outcome. We hypothesized that the patient-reported outcome would improve with time. Methods: Since 2001, patients 18 years and older with a DRF, at the Department of Orthopedics, Skåne University Hospital (Lund, Sweden) are prospectively registered in the Lund Wrist Fracture Register. We have previously defined a DASH score above 35 at the 1-year follow-up as the cutoff of major disability. Between 2003 and 2012,... (More)

Purpose: Most patients recover well from a distal radius fracture (DRF). However, approximately one-fifth have severe disability after 1 year when evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. In the present study, we evaluated this subgroup of patients in our register with an inferior outcome. We hypothesized that the patient-reported outcome would improve with time. Methods: Since 2001, patients 18 years and older with a DRF, at the Department of Orthopedics, Skåne University Hospital (Lund, Sweden) are prospectively registered in the Lund Wrist Fracture Register. We have previously defined a DASH score above 35 at the 1-year follow-up as the cutoff of major disability. Between 2003 and 2012, 17% of the patients (445 of 2,571) in the register exceeded this cutoff. Three hundred eighty-eight were women and 57 men and the mean age was 69 years (range, 18–95 years). One-fourth had been surgically treated. In December 2014, 2 to 12 years after the fracture, a follow-up DASH questionnaire was sent to the 346 of 445 patients still alive. Results: Seventy-three patients (27%) had initially been treated surgically and 196 (73%) nonsurgically for their DRF. Two hundred sixty-nine of 346 patients (78%) returned the follow-up DASH questionnaire at 2 to 12 years (mean, 5.5 years) after the fracture. The overall median DASH score improved from 50 at 1 year to 36 at the 2- to 12-year follow-up, (P <.05). Forty-seven percent had improved to a score below the cutoff 35, but 53% remained at a high suboptimal level. Conclusions: The subjective outcome after a DRF improves over time for patients with an inferior result at 1 year, but more than half of the patients continue to have major disability. Type of study/level of evidence: Prognostic II.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
DASH, Distal radius fracture, patient-reported outcome, residual disability, treatment
in
Journal of Hand Surgery
volume
44
issue
1
pages
39 - 45
publisher
Elsevier
external identifiers
  • scopus:85057286227
ISSN
0363-5023
DOI
10.1016/j.jhsa.2018.10.015
language
English
LU publication?
yes
id
ece2f7de-b583-4788-995f-ef3f7c1cc8c7
date added to LUP
2018-12-04 12:06:53
date last changed
2019-03-06 03:00:23
@article{ece2f7de-b583-4788-995f-ef3f7c1cc8c7,
  abstract     = {<p>Purpose: Most patients recover well from a distal radius fracture (DRF). However, approximately one-fifth have severe disability after 1 year when evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. In the present study, we evaluated this subgroup of patients in our register with an inferior outcome. We hypothesized that the patient-reported outcome would improve with time. Methods: Since 2001, patients 18 years and older with a DRF, at the Department of Orthopedics, Skåne University Hospital (Lund, Sweden) are prospectively registered in the Lund Wrist Fracture Register. We have previously defined a DASH score above 35 at the 1-year follow-up as the cutoff of major disability. Between 2003 and 2012, 17% of the patients (445 of 2,571) in the register exceeded this cutoff. Three hundred eighty-eight were women and 57 men and the mean age was 69 years (range, 18–95 years). One-fourth had been surgically treated. In December 2014, 2 to 12 years after the fracture, a follow-up DASH questionnaire was sent to the 346 of 445 patients still alive. Results: Seventy-three patients (27%) had initially been treated surgically and 196 (73%) nonsurgically for their DRF. Two hundred sixty-nine of 346 patients (78%) returned the follow-up DASH questionnaire at 2 to 12 years (mean, 5.5 years) after the fracture. The overall median DASH score improved from 50 at 1 year to 36 at the 2- to 12-year follow-up, (P &lt;.05). Forty-seven percent had improved to a score below the cutoff 35, but 53% remained at a high suboptimal level. Conclusions: The subjective outcome after a DRF improves over time for patients with an inferior result at 1 year, but more than half of the patients continue to have major disability. Type of study/level of evidence: Prognostic II.</p>},
  author       = {Landgren, Marcus and Teurneau, Vendela and Abramo, Antonio and Geijer, Mats and Tägil, Magnus},
  issn         = {0363-5023},
  keyword      = {DASH,Distal radius fracture,patient-reported outcome,residual disability,treatment},
  language     = {eng},
  number       = {1},
  pages        = {39--45},
  publisher    = {Elsevier},
  series       = {Journal of Hand Surgery},
  title        = {Intermediate-Term Outcome After Distal Radius Fracture in Patients With Poor Outcome at 1 Year : A Register Study With a 2- to 12-Year Follow-Up},
  url          = {http://dx.doi.org/10.1016/j.jhsa.2018.10.015},
  volume       = {44},
  year         = {2019},
}