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Polytrauma and High-energy Injury Mechanisms are Associated with Worse Patient-reported Outcomes After Distal Radius Fractures

van der Vliet, Q. M. J. MD; Sweet, A. A. R. BSc; Bhashyam, A. R. MD, MPP; Ferree, S. MD, PhD; van Heijl, M. MD, PhD; Houwert, R. M. MD, PhD; Leenen, L. P. H. MD, PhD, FACS; Hietbrink, F. MD, PhD

Clinical Orthopaedics and Related Research®: October 2019 - Volume 477 - Issue 10 - p 2267–2275
doi: 10.1097/CORR.0000000000000757

Background Patient-reported outcomes (PROs) are increasingly relevant when evaluating the treatment of orthopaedic injuries. Little is known about how PROs may vary in the setting of polytrauma or secondary to high-energy injury mechanisms, even for common injuries such as distal radius fractures.

Questions/purposes (1) Are polytrauma and high-energy injury mechanisms associated with poorer long-term PROs (EuroQol Five Dimension Three Levels [EQ-5D-3L] and QuickDASH scores) after distal radius fractures? (2) What are the median EQ-5D-3L, EQ-VAS [EuroQol VAS], and QuickDASH scores for distal radius fractures in patients with polytrauma, high-energy monotrauma and low-energy monotrauma

Methods This was a retrospective study with followup by questionnaire. Patients treated both surgically and conservatively for distal radius fractures at a single Level 1 trauma center between 2008 and 2015 were approached to complete questionnaires on health-related quality of life (HRQoL) (the EQ-5D-3L and the EQ-VAS) and wrist function (the QuickDASH). Patients were grouped according to those with polytrauma (Injury Severity Score [ISS] ≥ 16), high-energy trauma (ISS < 16), and low-energy trauma based on the ISS score and injury mechanism. Initially, 409 patients were identified, of whom 345 met the inclusion criteria for followup. Two hundred sixty-five patients responded (response rate, 77% for all patients; 75% for polytrauma patients; 76% for high-energy monotrauma; 78% for low-energy monotrauma (p = 0.799 for difference between the groups). There were no major differences in baseline characteristics between respondents and nonrespondents. The association between polytrauma and high-energy injury mechanisms and PROs was assessed using forward stepwise regression modeling after performing simple bivariate linear regression analyses to identify associations between individual factors and PROs. Median outcome scores were calculated and presented.

Results Polytrauma (intraarticular: β -0.11; 95% confidence interval [CI], -0.21 to -0.02]; p = 0.015) was associated with lower HRQoL and poorer wrist function (extraarticular: β 11.9; 95% CI, 0.4–23.4; p = 0.043; intraarticular: β 8.2; 95% CI, 2.1–14.3; p = 0.009). High-energy was associated with worse QuickDASH scores as well (extraarticular: β 9.5; 95% CI, 0.8–18.3; p = 0.033; intraarticular: β 11.8; 95% CI, 5.7–17.8; p < 0.001). For polytrauma, high-energy trauma, and low-energy trauma, the respective median EQ-5D-3L outcome scores were 0.84 (range, -0.33 to 1.00), 0.85 (range, 0.17–1.00), and 1.00 (range, 0.174–1.00). The VAS scores were 79 (range, 30–100), 80 (range, 50–100), and 80 (range, 40–100), and the QuickDASH scores were 7 (range, 0– 82), 11 (range, 0–73), and 5 (range, 0–66), respectively.

Conclusions High-energy injury mechanisms and worse HRQoL scores were independently associated with slightly inferior wrist function after wrist fractures. Along with relatively well-known demographic and injury characteristics (gender and articular involvement), factors related to injury context (polytrauma, high-energy trauma) may account for differences in patient-reported wrist function after distal radius fractures. This information may be used to counsel patients who suffer a wrist fracture from polytrauma or high-energy trauma and to put their outcomes in context. Future research should prospectively explore whether our findings can be used to help providers to set better expectations on expected recovery.

Level of Evidence Level III, therapeutic study.

Q. M. J. van der Vliet, A. A. R. Sweet, A. R. Bhashyam, R. M. Houwert, L. P. H. Leenen, F. Hietbrink, University Medical Center Utrecht, Department of Traumatology, Utrecht, The Netherlands

S. Ferree, M. van Heijl, Diakonessenhuis Utrecht, Department of Surgery, Utrecht, The Netherlands

Q. M. J. van der Vliet, Heidelberglaan 100, Room G.04.228, 3508 GA Utrecht, The Netherlands, Email:

Each author certifies that neither he or she, nor any member of his or her immediate family, have funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Investigation performed at University Medical Center Utrecht, The Netherlands.

Received October 12, 2018

Accepted March 12, 2019

Online date: April 9, 2019

© 2019 Lippincott Williams & Wilkins LWW
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