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Updated: May 28, 2026
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Published on: March 13, 2026
Patient-Reported Outcomes After Distal Radius Fractures Differ Across Geographic and Cultural Populations: A Global
Robert E Bilodeau1,2, Rishabh S Bhadouriya1,2, Craig E Klinger1
1Department of Orthopaedic Trauma, Hospital for Special Surgery, New York, USA.
Objectives:
To assess patient reported outcome (PRO) heterogeneity across different cultural and geographical regions via a systematic review and meta-analysis of PROs following volar plate fixation of distal radius fractures.
Methods:
Data Sources: PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for randomized controlled trials from 2010 to 2023 reporting Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH, Patient-Rated Wrist Evaluation (PRWE), or Visual Analogue Scale (VAS) PROs.
Study Selection:
Randomized controlled trials with treatment arms consisting of open reduction and internal fixation utilizing a volar locking plate for adult distal radius fracture (OTA/AO 23) and reported DASH, QuickDASH, PRWE, or VAS PROs were included. Studies not published in English or that provided insufficient extraction data were excluded.
Data Extraction:
Studies were characterized by country of origin, continent of origin, and cultural region of origin. Extracted data included PRO outcomes, patient demographics, and follow-up ranges.
Data Synthesis:
Random-effects meta-analysis was performed with Restricted Maximum Likelihood method, and subgroup analyses were performed to determine differences in pooled PROs across geographical and cultural regions.
Results:
52 treatment arms met inclusion criteria for DASH analysis, 33 for PRWE, and 23 for VAS. Significant mean DASH score heterogeneity existed across all studies (p<0.01). Nine cultural regions were represented in the DASH analysis and demonstrated significantly different pooled mean PRO scores (p<0.01). Significant mean PRWE score heterogeneity existed across all studies (p<0.01). Seven cultural regions were represented in the PRWE analysis and demonstrated significantly different pooled mean PRO scores (p<0.01). Significant mean VAS score heterogeneity existed across all studies (p<0.01). Eight cultural regions were represented in the VAS analysis and demonstrated significantly different pooled mean PRO scores (p<0.01).
Conclusions:
Patient reported outcomes following distal radius volar plate fixation demonstrated meaningful variation across cultural and geographic contexts. Outcomes from one cultural region may not be globally generalizable.
Level Of Evidence:
Therapeutic, Level I.
