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Preoperative Factors Associated With Early- to Medium-Term Patient-Reported Outcomes Following Volar Locking Plate
Martin Franke1, Samuel Raymond1, James Ledgard1
1Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Introduction:
Distal radius fractures are common injuries with a substantial burden of disease. Although volar locking plate fixation is commonly used, the relationship between preoperative factors and early- to medium-term patient-reported outcomes remains poorly delineated. This study examined whether patient characteristics, injury features and routine prereduction radiographic measurements were associated with 3-month Patient-Rated Wrist and Hand Evaluation (PRWHE) scores after volar locking plate fixation.
Methods:
A retrospective cohort study at a tertiary trauma centre was conducted. Adults who underwent volar locking plate fixation were identified from a prospectively maintained registry. Demographics, comorbidities, injury details and prereduction radiographs were reviewed. The primary outcome was the PRWHE score at 3 months postoperative. Grip strength and range of motion were also assessed, where available. Multivariable linear regression analysis evaluated associations between preoperative factors and PRWHE scores. Sensitivity analysis utilised complete-case analysis, and paired testing was used to assess temporal associations.
Results:
Amongst prereduction radiographic factors, greater sagittal translation and ulnar styloid fracture were associated with poorer patient-reported outcomes. Older age was associated with worse function, and female sex was associated with better outcomes. When considering clinician-measured outcomes, greater grip strength and ulnar deviation were associated with superior patient-reported outcomes. Analysis of the small paired 3- to 6-month cohort revealed improvement in pain, grip strength and wrist range of motion.
Conclusion:
Certain prereduction radiographic features, male sex and older age are associated with poorer patient-reported outcomes following volar locking plate fixation of distal radius fractures. These findings may assist in preoperative counselling, prognostication and identification of patients at risk.
Level Of Evidence:
III.