Perfect Anatomic Alignment in Distal Radius Fractures Does Not Mean Better Patient Outcomes

A new study examined whether precise anatomic restoration for distal radius fractures (DRFs) is associated with improved functional and patient-reported outcomes and found they may not be related.

Each year, about 90,000 adults in the U.S. sustain DRFs, which constitute nearly one in every five fractures seen by physicians and are the second most common among older adults, according to the study authors.

In their reasoning for undertaking the current study, the researchers wrote, “Previous studies of DRF outcomes in persons who are aged 60 years and older report that precise anatomic reduction is not necessary to achieve satisfactory functional results because this population requires less functional recovery than younger patients. However, these conclusions cannot be applied to the current population of older adults who are much more active and functionally independent than previous generations. The perceived effect of disability from DRF will be more pronounced in the current population aged 60 years and older with greater demand in functional capacity.”

For their analysis, the researchers gathered data from the Wrist and Radius Injury Surgical Trial (WRIST). The multicenter, randomized clinical trial evaluated treatments for DRFs in adults aged 60 years and older. Patients were enrolled between April 10, 2012, and Dec. 31, 2016; data were analyzed between Jan. 3, 2019, and Aug. 19, 2019. Patients were randomly assigned to one of the following treatments: volar locking plate, percutaneous pinning, or external fixation; nonoperative patients underwent casting. The primary outcomes were 12-month hand grip strength, wrist arc of motion, radial deviation, ulnar deviation, the Michigan Hand Outcomes Questionnaire (MHQ) total score, MHQ function score, and MHQ activities of daily living (ADL) score.

Perfection Does Not Equate to Satisfaction in DRF

Final analysis included 166 WRIST patients (mean [SD] age, 70.9 [8.9] years; 144 [86.7%] were female). According to the study authors, “only 2 of the 84 correlation coefficients calculated were statistically significant.” Among patients aged 70 years and older, every degree increase in radial inclination away from a normal grip strength of 22 degrees in the fracture hand was 1.1 kg weaker compared to the contralateral hand (95% confidence interval [CI], 0.38–1.76; P=0.004). for every millimeter increase toward a normal ulnar variance of 0 mm, a 10.4-point improvement was observed in MHQ ADL score (95% CI, –16.84 to –3.86). Still, neither measurement was correlated with MHQ total or function scores.

The study was published in JAMA Network Open.

“With this evidence, surgeons may elect to decrease operative time, use of resources, and associated costs that would have been spent to achieve perfect or near-perfect reduction,” the study authors wrote in their conclusion, adding, “In the treatment decision-making process, surgeons can prioritize patient preferences over the need to achieve exact realignment.”