gms | German Medical Science

Objective: 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 describe such factors in a distal radius fracture cohort using a "yellow flags" questionnaire as recorded in a prospective and consecutive DRF register.

Materials and Methods: Two weeks after the injury, all 1650 patients in working age 18-65 years with a distal radius fracture 2004-2013 were sent the "yellow flags" questionnaire regarding general health, socioeconomic background, previous pain experience and coping of the present injury. 1205 patients replied and sent in the questionnaire.

Results: 71% of the patients were married, 17% single and 9% divorced. 20% were first generation immigrants, 45% had a university degree, and 21% smoked. 18% were on sick leave at time of fracture or were already retired in spite of still being in working age <65 years. Only 6% considered their daily work heavy. 10% of the fractured population had previously been on sick leave for more than 30 days. These patients replied to four extra questions regarding pain coping.

Conclusions: 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. Pain coping mechanisms are therefore important to charter, for example using a questionnaire, to optimize the non-surgical part of the treatment. Education level, cultural background may influence how this treatment should be presented to the patient. We must carefully identify factors causing excessive pain experience, like, massive edema, inability to adhere to rehab protocol, fear of movement or suboptimal coping mechanisms.