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Pre-injury activity predicts outcomes following distal radius fractures in patients age 60 and older

INTRODUCTION: One out of every 5 elderly patients will suffer a distal radius fracture and these injuries are often related to poor bone health. Several surgical subspecialties have demonstrated that pre-injury activity level can impact patient outcomes. To determine the importance of physical activ...

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Autores principales: Hooper, Rachel C., Zhou, Nina, Wang, Lu, Shauver, Melissa J., Chung, Kevin C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239474/
https://www.ncbi.nlm.nih.gov/pubmed/32433648
http://dx.doi.org/10.1371/journal.pone.0232684
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author Hooper, Rachel C.
Zhou, Nina
Wang, Lu
Shauver, Melissa J.
Chung, Kevin C.
author_facet Hooper, Rachel C.
Zhou, Nina
Wang, Lu
Shauver, Melissa J.
Chung, Kevin C.
author_sort Hooper, Rachel C.
collection PubMed
description INTRODUCTION: One out of every 5 elderly patients will suffer a distal radius fracture and these injuries are often related to poor bone health. Several surgical subspecialties have demonstrated that pre-injury activity level can impact patient outcomes. To determine the importance of physical activity, we examined the relationship between pre-injury activity and patient-reported and functional outcomes among fracture patients. METHODS: This is a retrospective analysis of prospectively collected data from participants enrolled in the Wrist and Radius Injury Surgical Trial (WRIST) from April 10, 2012 to December 31, 2016. This study included 304 adults, 60 years or older with isolated unstable distal radius fractures; 187 were randomized to one of three surgical treatments and 117 opted for casting. Participants opting for surgery were randomized to receive volar locking plate, percutaneous pinning, or external fixation. Participants who chose not to have surgery were treated with casting. All participants were stratified prior to analysis into highly and less-active groups based on pre-injury Rapid Assessment of Physical Activity Scores. RESULTS: 280 patients had 12-month assessments of outcomes. Highly active participants scored 8 and 5 points greater on the Michigan Hand Questionnaire at 6 weeks and 3 months respectively, p<0.05. Highly active participants demonstrated greater grip strength at the 3-month (p = 0.017) and 6-month (p = 0.007) time-points. Highly active participants treated with volar locking plate scored 10+ points greater on the Michigan Hand Questionnaire compared to the less-active group at the 6-week (p = 0.032), 3-month (p = 0.009) and 12-month (0.004) time points, with an effect size larger than 0.50, suggesting pre-injury level of activity had a significant clinical impact. CONCLUSIONS: Higher levels of pre-injury activity are predictive of patient-reported and functional outcomes following distal radius fracture. Because of the greater PROs, the early mobility and lower risk of hardware infection reported in the literature, volar plating is preferable to other treatments for highly active patients who request and meet indications for surgery. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01589692.
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spelling pubmed-72394742020-06-08 Pre-injury activity predicts outcomes following distal radius fractures in patients age 60 and older Hooper, Rachel C. Zhou, Nina Wang, Lu Shauver, Melissa J. Chung, Kevin C. PLoS One Research Article INTRODUCTION: One out of every 5 elderly patients will suffer a distal radius fracture and these injuries are often related to poor bone health. Several surgical subspecialties have demonstrated that pre-injury activity level can impact patient outcomes. To determine the importance of physical activity, we examined the relationship between pre-injury activity and patient-reported and functional outcomes among fracture patients. METHODS: This is a retrospective analysis of prospectively collected data from participants enrolled in the Wrist and Radius Injury Surgical Trial (WRIST) from April 10, 2012 to December 31, 2016. This study included 304 adults, 60 years or older with isolated unstable distal radius fractures; 187 were randomized to one of three surgical treatments and 117 opted for casting. Participants opting for surgery were randomized to receive volar locking plate, percutaneous pinning, or external fixation. Participants who chose not to have surgery were treated with casting. All participants were stratified prior to analysis into highly and less-active groups based on pre-injury Rapid Assessment of Physical Activity Scores. RESULTS: 280 patients had 12-month assessments of outcomes. Highly active participants scored 8 and 5 points greater on the Michigan Hand Questionnaire at 6 weeks and 3 months respectively, p<0.05. Highly active participants demonstrated greater grip strength at the 3-month (p = 0.017) and 6-month (p = 0.007) time-points. Highly active participants treated with volar locking plate scored 10+ points greater on the Michigan Hand Questionnaire compared to the less-active group at the 6-week (p = 0.032), 3-month (p = 0.009) and 12-month (0.004) time points, with an effect size larger than 0.50, suggesting pre-injury level of activity had a significant clinical impact. CONCLUSIONS: Higher levels of pre-injury activity are predictive of patient-reported and functional outcomes following distal radius fracture. Because of the greater PROs, the early mobility and lower risk of hardware infection reported in the literature, volar plating is preferable to other treatments for highly active patients who request and meet indications for surgery. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01589692. Public Library of Science 2020-05-20 /pmc/articles/PMC7239474/ /pubmed/32433648 http://dx.doi.org/10.1371/journal.pone.0232684 Text en © 2020 Hooper et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Hooper, Rachel C.
Zhou, Nina
Wang, Lu
Shauver, Melissa J.
Chung, Kevin C.
Pre-injury activity predicts outcomes following distal radius fractures in patients age 60 and older
title Pre-injury activity predicts outcomes following distal radius fractures in patients age 60 and older
title_full Pre-injury activity predicts outcomes following distal radius fractures in patients age 60 and older
title_fullStr Pre-injury activity predicts outcomes following distal radius fractures in patients age 60 and older
title_full_unstemmed Pre-injury activity predicts outcomes following distal radius fractures in patients age 60 and older
title_short Pre-injury activity predicts outcomes following distal radius fractures in patients age 60 and older
title_sort pre-injury activity predicts outcomes following distal radius fractures in patients age 60 and older
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239474/
https://www.ncbi.nlm.nih.gov/pubmed/32433648
http://dx.doi.org/10.1371/journal.pone.0232684
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