gms | German Medical Science

Objectives/Interrogation: For most patients with distal radial fracture (DRF), the outcome is good but 15-20 % have suboptimal subjective results one year after the injury (Landgren 2018). Previous long term studies have focused mainly on radiographic appearances as predictors of inferior subjective outcome but personal factors like pain coping strategies and pain behaviour may play a similar or even larger role. The aim of this study was to identify such factors which may predict poor outcome, thereby providing us with instruments to identify and treat complications before they become manifest.

Methods: 1045 patients, 18-65 years with a distal radius fracture 2003-2012 were sent a "yellow flags" questionnaire regarding general health, socioeconomic background, previous pain experience and coping of the present injury. One year after the injury, quick-DASH, a validated subjective outcome questionnaire was distributed. The two questionnaires were merged and analyzed using Matlab and SPSS. Linear regression was used to evaluate correlation between the information from the initial treatment and the qDASH-evaluated outcome. The included cases were then analyzed using SPSS automatic linear modeling to identify the most important predictors of a patient's one-year qDASH outcome.

Results: 645 patients had full data from both the early yellow flags questionnaire and the 12-month DASH. Using the automated linear model, approximately 30 % of the 12-month DASH outcome was explained by the first week yellow flags predictors. The self-evaluated pain level at the time of injury was by far the single best predictor of the one-year qDASH outcome. Other factors such as comorbidities and education level had minor impact on the outcome.

Conclusion: The level of pain as experienced by the patient during the first weeks after the fracture seems to be the most important factor to predict a high one year qDASH-score. Increased efforts to help the patient control/cope with the initial pain after the fracture are therefore important and controlled, prospective preferably randomized studies necessary. With the present tragic opioid crisis in mind, it is important not only to focus on pharmacological treatment. We must carefully identify other factors causing excessive pain experience, like, massive edema, inability to adhere to rehab protocol, fear of movement or suboptimal coping mechanisms.