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Variation in the Incidence of Distal Radius Fractures in the U.S. Elderly as Related to Slippery Weather Conditions

Giladi, Aviram M. M.D.; Shauver, Melissa J. M.P.H.; Ho, Allison B.S.; Zhong, Lin M.D., M.P.H.; Kim, H. Myra Sc.D.; Chung, Kevin C. M.D., M.S.

Plastic and Reconstructive Surgery: February 2014 - Volume 133 - Issue 2 - p 321–332
doi: 10.1097/01.prs.0000436796.74305.38
Hand/Peripheral Nerve: Original Articles
Video Discussion

Background: Distal radius fractures are costly and debilitating injuries, especially for the elderly. These fractures often occur from falls and commonly occur outdoors. Inclement weather may increase the risk of fall-related injuries. Small studies have reported an increased risk of distal radius fracture caused by inclement winter weather; larger studies are lacking.

Methods: The authors analyzed a sample of 2007 Medicare claims for distal radius fracture. Weather data were collected for the date and location of each distal radius fracture in the authors’ analysis cohort. A novel slipperiness score was used as a measure of the severity of slippery outdoor conditions. Negative binomial regression models evaluated the correlation between slipperiness and distal radius fracture occurrence.

Results: Risk of distal radius fracture was higher in winter months (incidence rate ratio, 1.2; p < 0.001). Days with average temperature less than or equal to 32°F (incidence rate ratio, 1.36; p < 0.001), snow/ice on the ground at the start of the day (incidence rate ratio, 1.45; p < 0.001), and freezing rain (incidence rate ratio, 1.24; p = 0.025) all had an increased risk of distal radius fracture. The risk of sustaining a distal radius fracture was increased 21 percent on days with a slipperiness score above 4 (incidence rate ratio, 1.21; p = 0.007). For each increase in slipperiness score above 4, the incidence rate ratio of distal radius fracture increased as well.

Conclusions: Weather events that create slippery walking conditions, often in the winter, result in an increased risk of distal radius fracture in the elderly. This finding can be used to support resource allocation and awareness and prevention campaigns.


Video Discussion by Alexander Spiess, M.D., is available online for this article.

Ann Arbor, Mich.

From the Department of Surgery, Section of Plastic Surgery, University of Michigan Health System; the Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School; and the Center for Statistical Consultation and Research, University of Michigan.

Received for publication June 28, 2013; accepted August 13, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Kevin C. Chung, M.D., M.S., 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109,

©2014American Society of Plastic Surgeons