Jones Christopher M, Ramsey Randle W, Ilyas Asif, Abboudi Jack, Kirkpatrick William, Kalina Thomas, Leinberry Charles
Rothman Institute at Jefferson, Philadelphia, PA.
Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA.
J Hand Surg Am. 2017 Sep;42(9):700-704.e2. doi: 10.1016/j.jhsa.2017.05.030.
A major concern for patients following distal radius fracture fixation is when they can resume driving. This decision has medical, legal, and safety considerations, but there are no evidence-based guidelines to assist the surgeon. The goal of this study was to observe when patients are capable of safely resuming driving following surgical fixation of the distal radius.
Patients undergoing volar plating of a distal radius fracture were prospectively enrolled. At approximately 2 and 4 weeks after surgery, patients were administered a driving examination on a closed course and given a subjective questionnaire including visual analog scale scores. All basic functions of vehicle operation were evaluated. Successful completion indicated they would pass a driving evaluation.
Twenty-three patients were enrolled. Sixteen (69.5%) passed their first attempt (average of 18.4 days from surgery), another 4 (17.4%) passed their second attempt (31.3 days from surgery), and 3 did not complete the second examination. Patients who failed relied too much on their nonsurgical hand, were not able to control the steering wheel with 2 hands, and reported pain and insecurity when using the operative hand. Of those who passed the second attempt, the first failure was universally attributed to pain. Fifteen patients reported a return to independent driving prior to the first examination (average, 11.3 days). Of the 7 who failed, 6 reported they could control the car in an emergency, and 2 reported they would not feel safe with daily driving. Maximum pain while driving on the visual analog scale was 2.4 of 10 among those who failed compared with 1.3 among those who passed.
Most patients could safely return to driving within 3 weeks of surgery. Pain was the primary limiting factor affecting driving ability. Safe return to driving may be warranted within 3 weeks of distal radius volar plate fixation in some patients. Persistent pain is likely the most important obstacle to a safe return to driving.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
