The impact of patient activity level on wrist disability after distal radius malunion in older adults

• Published in: Journal of orthopaedic trauma Vol. 29; no. 4; p. 195
• Main Authors: Nelson, Gregory N, Stepan, Jeffrey G, Osei, Daniel A, Calfee, Ryan P
• Format: Journal Article
• Language: English
• Published: United States 01.04.2015
• Subjects: Aged; Cross-Sectional Studies; Disability Evaluation; Female; Fracture Healing; Fractures, Malunited - diagnosis; Fractures, Malunited - rehabilitation; Fractures, Malunited - surgery; Humans; Male; Motor Activity; Radius Fractures - diagnosis; Radius Fractures - rehabilitation; Radius Fractures - surgery; Range of Motion, Articular; Recovery of Function; Treatment Outcome; Wrist Injuries - diagnosis; Wrist Injuries - rehabilitation; Wrist Injuries - surgery
• ISSN: 1531-2291
• DOI: 10.1097/BOT.0000000000000235

To determine if high-activity older adults are adversely affected by distal radius malunion. Cross-sectional study. Hand clinics at a tertiary institution. Ninety-six patients 60 years or older at the time of fracture were evaluated at least 1 year after distal radius fracture. Physical Activity Scale of the Elderly scores stratified participants into high- and low-activity groups. Malunions were defined radiographically by change of ≥20 degrees of lateral tilt, ≥15 degrees radial inclination, ≥4 mm of ulnar variance, or ≥4 mm intra-articular gap or step-off, compared with the uninjured wrist. Patient-rated disability of the upper extremity was measured by the QuickDASH and visual analog scales (VAS) for pain/function. Strength and motion measurements objectively quantified wrist function. High-activity participants with a distal radius malunion were compared with high-activity participants with well-aligned fractures. There was no significant difference in QuickDASH scores, VAS function, strength, and wrist motion despite statistically, but not clinically, relevant increases in VAS pain scores (difference 0.5, P = 0.04) between the groups. Neither physical Activity Scale of the Elderly score (β = 0.001, 95% confidence interval: -0.002 to 0.004) nor malunion (β = 0.133, 95% confidence interval: -0.26 to 0.52) predicted QuickDASH scores in regression modeling after accounting for age, sex, and treatment. Operative management failed to improve outcomes and resulted in decreased grip strength (P = 0.05) and more frequent complications (26% vs. 7%, P = 0.01) when compared with nonoperative management. Even among highly active older adults, distal radius malunion does not affect functional outcomes. Judicious use of operative management is warranted provided heightened complication rates. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.