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Distal radius fracture patients show declined ability of dynamic body balancing
Koji Fujita, MD, PhD1; Hidetoshi Kaburagi, MD1; Akimoto Nimura, MD, PhD1; Takashi Miyamoto, MD, PhD1; Yoshiaki Wakabayashi, MD, PhD2; Yasuhiro Seki, MD3; Hiromichi Aoyama, MD4; Tetsuya Sato, MD5; Haruhiko Shimura, MD, PhD5; Shiro Suzuki, MD, PhD6; Kato Ryuichi, MD, PhD7; Atsushi Okawa, MD, PhD1
1Tokyo Medical and Dental University, Tokyo, Japan; 2Minato Red Cross Hospital, Yokohama?Kanagawa, Japan, 3Suwa Central Hospital, Nagano, Japan; 4JA Toride Medical Center, Ibaragi, Japan; 5Tokyo Bay Urayasuichikawa Medical Care Center, Chiba, Japan; 6Tamahokubu Medical Center, Tokyo, Japan; 7JA Kyosai Research Institute, Tokyo, Japan

Background
Fragility fractures of the distal radius are associated with an increased risk of future hip and spine fracture, thus the importance of body balancing ability and bone quality is well acknowledged for falls and secondary fracture prevention. Here, we assessed the body balancing ability, grip strength and bone quality of patients with distal radius fractures who underwent surgery.

Methods
This study is a prospective multicenter study, approved by IRA. Subjects are 94 women (age > 45-year-old) with distal radius fractures as first fragility fracture, who underwent surgery in registered hospitals from January to December in 2015. Two weeks after surgery, body balancing ability was measured by four methods, Functional Reach Test (FRT), Timed Up and Go test (TUG), 2 Step test (2ST) and Timed Unipedal Stance test with eye open (TUS). 2S is the score which maximum length of double stride divided by own height. Grip strength on the non-fracture side (GS) and bone density (T-score) were also measured at the same time point. Statistical analysis was performed by Student's t test to compare with Japanese normative values and p < 0.05 was considered as significant.

Results
FRT is 29.6 cm in 40s (p = 0.03), 31.1 cm in 50s (p = 0.002), 32.5 cm in 60s (p < 0.001) and 28.2 cm in 70s (p < 0.001). TUG is 7.7 seconds (S) in 50s (p < 0.001), 7.1S in 60s (p = 0.002) and 8.1S in 70s (p = 0.004). 2ST is 1.40 in 40s, 1.32 in 50s (p = 0.003), 1.29 in 60s (p < 0.001), 1.21 in 70s (p < 0.001) and 1.02 in 80s (p = 0.01). TUS was 55S in 60s (p < 0.001). GS was 20.9 kg in 50s, 19.3 kg in 60s and 18.2 kg in 80s. Only 25 % of subjects showed lower T-score than -2.5.

Summary
The patients with distal radius fractures in 50s, 60s and 70s showed significantly lower body balancing ability, especially during dynamic motion like FRT, TUG, 2ST. GS was also significantly lower in 50s, 60s and 80s. 75% of patients did not show osteoporotic status. It is compatible to the fact that distal radius fractures are tend to be primary fragility fracture and patients were relatively younger. The patients with distal radius fractures should be identified as "high risk" of falls and secondary fractures. Intensive training could be effective for fall prevention.


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