Wrist trauma. Diagnosis, Treatment and Prognosis

Abstract

This thesis aimed to improve diagnosis, treatment and prognosis of patients with wrist trauma. To this end, we performed several multicentre prospective and retrospective studies. In Part 1, we derived and externally validated a clinical decision rule for both adult and paediatric patients with wrist trauma and named these the Amsterdam Wrist Rules (AWR) and the Amsterdam Paediatric Wrist Rules (APWR). These rules can provide physicians in the Emergency Department with a useful screening tool to select patients with acute wrist trauma for radiography. We found that, although at the cost of missing a fracture (without therapeutic consequences) in 4.3% of the patients, the use of the APWR would have resulted in a 22% absolute reduction of radiographs. In Part 2, we performed a study to examine the variation in surgical treatment rate of patients with distal radius fractures across all Dutch hospitals and examined 95,754 reimbursements. We found that the operative rate across hospitals ranged from 0% to 23% and could not be explained by the hospital type and characteristics of the patient population. In Part 3 we focussed on the prognosis of patients with distal radius fractures. The outcome of treatment is often measured with patient-reported outcome measures such as the Patient-rated Wrist Evaluation score (PRWE). However, to interpret these results one should be aware of the minimal numeric change in score that constitutes a clinical change for the patien (the minimum clinically important difference [MCID]). We determined the MCID of the PRWE for patients with distal radius fractures and found it is 11.5 points. We recommend using this when evaluating the effects of treatments and when performing sample-size calculations for future studies.