Sat., 10/20/07 Upper Extremity, Paper #58, 11:13 am OTA-2007
Determinants of Health Status and Wrist Function after Operative Fixation of Distal Radius Fractures
J. Sebastiaan Souer, MD (a-AO Foundation, Small Bone Innovations, Smith+Nephew Richards, Wright Medical, Joint Active Systems, Biomet, Prof. Michael van Vloten Fonds);
Lozano-Calderon Santiago, MD (a-AO Foundation, Small Bone Innovations, Smith+Nephew Richards, Wright Medical, Joint Active Systems, Biomet, Prof. Michael van Vloten Fonds);
Jesse Jupiter, MD (a-AO Foundation, Small Bone Innovations, Smith+Nephew Richards,
Wright Medical, Joint Active Systems; e-Wyeth Co., Amgen Co.);
David Ring, MD, PhD (a-AO Foundation, Small Bone Innovations, Joint Active Systems, Biomet; c-Hand Innovations; a,e-Smith+Nephew Richards, Wright Medical);
Massachusetts General Hospital, Boston, Massachusetts, USA
Purpose: This aim of this study was to identify the most important determinants of physician-based and patient-based scoring systems for the wrist and upper extremity after operative treatment of a fracture of the distal radius. Our specific hypothesis was that pain is the strongest determinant of both types of scores.
Methods: 84 patients were evaluated a minimum of 6 months after operative fixation of an unstable distal radius fracture using two physician-based evaluation instruments (The Mayo Wrist Score and the Gartland and Werley Score) and an upper extremity specific health status questionnaire (Disabilities of the Arm, Shoulder and Hand [DASH]). Multivariate analysis of variance and multiple linear regression modeling were used to identify the degree to which various factors affect variability in the scores derived with these measures.
Results: The physician-based scoring systems showed moderate correlation (r = -0.32, P = 0.003) with each other and with DASH scores (r[GW] = 0.41, P <0.001; r[Mayo] = -0.32; P = 0.003). The results of multiple linear regression modeling were as follows (percent variability accounted for by the best fit model/ model with top factor alone): Mayo score, 54% grip and flexion arc/47% grip alone; Gartland and Werley, 70% pain, flexion arc, radiocarpal arthritis, and duration of follow-up/53% pain alone; DASH, 71% pain, forearm arc, and type of fracture/65% pain alone.
Conclusion: Pain dominates the patient’s perception of function after recovery from a distal radius fracture as measured by the DASH score and the physician-based rating according to the system of Gartland and Werley. The Mayo score is determined by grip strength rather than pain.
Significance: Because the perception of pain and strength of grip are influenced by psychosocial factors, both patient-based and physician-based measures of wrist function after fracture of the distal radius may reflect illness behavior as much as objective pathology.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.