Do Patients With an Inferior Subjective Result 12 Months After a Distal Radius Fracture Improve Over Time? A Prospective Register Study

Abstract

Objective/Hypothesis: The majority of patients with a distal radius fracture recover during the first half year, but approximately 10% to 15% have substantial problems still after 1 year when evaluated using patient-reported outcome scores. In the present study, we used the data from a prospective register to evaluate the longer term subjective outcome in patients who had a suboptimal subjective outcome at the 12-month follow-up. We hypothesized that the subjective outcome would improve over time. Methods: At our hospital, approximately 450 adult patients (18 years and older) are treated for a distal radius fracture each year. Since 2001, these patients are prospectively and consecutively registered, and a subjective outcome questionnaire (Disability of the Arm, Shoulder and Hand [DASH]) is sent to the patients after 3 and 12 months. In the present study, we arbitrarily defined a suboptimal DASH score of >35 and found 463/2666 patients in the register with a fracture between 2003 and 2012, who exceeded DASH 35 at 12 months. In fall 2014, 2 to 9 years after the fracture, a DASH inquiry was sent to the surviving 351 patients. Results: In all, 279 patients returned the new DASH inquiry. Forty-six percent had improved over time, reporting a DASH score below the cutoff, but 56% remained at a high suboptimal level of >35. No time dependent improvement could be detected, regardless if the minimum 2 or the maximum 9 years had passed since the fracture. Patients with a persisting high DASH score were older at the time of fracture (66.5 years vs 63.6, P = .04). Men seemed to improve more than women, from median 52 at 12 months after fracture to 25, compared with women who improved from median 50 to 39 ( P = .02). The men, however had a substantially lower mean age at time of fracture (53.7), compared with the women (67.4, P < .01). Conclusion: (1) An inferior result after 1 year will remain over time for many patients. (2) About half the patients improve and end up below the arbitrarily set threshold. (3) About half the patients continue to report a suboptimal subjective outcome. (4) No trend was found indicating that these patients get better with time. (5) Given the high incidence of a distal radius fracture, a small proportion of suboptimal results do matter and every effort should be made to improve the early results.