Hand Surgery Fellow, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States of America.
PhD Candidate, Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America.
PLoS One. 2020 May 20;15(5):e0232684. doi: 10.1371/journal.pone.0232684. eCollection 2020.
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.
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.
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.
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.
clinicaltrials.gov identifier: NCT01589692.
每 5 名老年患者中就有 1 人会遭受桡骨远端骨折，这些损伤通常与骨骼健康状况不佳有关。多个外科亚专业已经证明，受伤前的活动水平会影响患者的预后。为了确定体力活动的重要性，我们研究了骨折患者受伤前活动与患者报告的结果和功能结果之间的关系。
这是对 2012 年 4 月 10 日至 2016 年 12 月 31 日期间参加腕关节和桡骨损伤外科试验（WRIST）的前瞻性收集数据进行的回顾性分析。这项研究包括 304 名年龄在 60 岁或以上的、患有孤立性不稳定桡骨远端骨折的成年人；其中 187 人被随机分配到三种手术治疗方法之一，117 人选择了石膏固定。选择手术的患者被随机分配接受掌侧锁定板、经皮钢针或外固定。选择不手术的患者接受石膏固定。所有参与者在分析前根据受伤前快速身体活动评估得分分为高度活跃和低活跃组。
280 名患者在 12 个月时进行了结果评估。高度活跃组在受伤后 6 周和 3 个月时密歇根手部问卷评分分别高 8 分和 5 分，p<0.05。高度活跃组在 3 个月（p = 0.017）和 6 个月（p = 0.007）时的握力更大。与低活跃组相比，接受掌侧锁定板治疗的高度活跃组在受伤后 6 周（p = 0.032）、3 个月（p = 0.009）和 12 个月（p = 0.004）时密歇根手部问卷评分高 10 分以上，其效应量大于 0.50，表明受伤前的活动水平对桡骨远端骨折后患者报告的结果和功能结果有显著的临床影响。
受伤前较高的活动水平可预测桡骨远端骨折后的患者报告结果和功能结果。由于文献报道的患者报告的结果更好、早期活动度更高以及硬件感染风险更低，因此对于要求手术且符合手术指征的高度活跃患者，掌侧钢板固定比其他治疗方法更可取。
clinicaltrials.gov 标识符：NCT01589692。
