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When is it Safe to Drive After Distal Radius Fracture Fixation
Christopher Jones, MD1; Randle William Ramsey, DO2; Asif I Ilyas, MD1; Jack Abboudi, MD1; William Kirkpatrick, MD1; Tom Kalina, OTR3; Charles Leinberry, MD1
1Thomas Jefferson University Hospital, Philadelphia, PA; 2Philadelphia College of Osteopathic Medicine, Philadelphia, PA; 3Bryn Mawr Rehab Hospital, Malvern, PA

Introduction: One of the most common patient concerns following surgical fixation of the distal radius is when they can resume driving. This decision has important medical, legal and safety considerations, but there are no evidence based guidelines to assist the surgeon. The purpose of this study was to determine when patients who underwent volar plating of the distal radius can safely return to driving.

Materials and Methods: Patients who had undergone volar plating of a distal radius fracture were prospectively enrolled. Their driving skills were evaluated at approximately 2 and 4 weeks post surgery by an independent driving rehabilitation specialist. The exam was performed on a closed course and all basic functions of vehicle operation and driving skill were evaluated. Successful completion indicated they would pass a Pennsylvania Department of Transportation Driving Evaluation. Additionally, the patient's hand function was evaluated by a certified hand therapist and through patient reported pain VAS scores.

Results: Twenty four patients were enrolled. Seventeen of the 24 (70%) passed on the first try (average of 19.4 days from surgery), another 4 (16.7%) on the second try (at an average of 31.3 days from surgery), and 3 did not complete the second exam. Patients who failed relied too exclusively on their non-operative hand, were not able to control the steering wheel with two hands, and reported pain and insecurity when using the operative hand. Of those who passed the second attempt, pain was universally attributed to the first failure. Fifteen patients reported return to independent driving prior to the first exam at an average of 11.27 days from surgery. Of the 7 patients who failed, all but one reported they could control the car in an emergency, yet 2 reported they would not feel safe with daily driving. Common difficulties included managing the ignition, fastening a seatbelt and quick turning of the steering wheel. Maximum pain while driving, on the VAS scale, was 2.4/10 among those who failed compared to 1.3 among those who passed.

Conclusion: The majority of patients were able to safely return to driving within 3 weeks of surgery. Pain was the primary limiting factor affecting driving ability. Safe return to driving may be warranted within 3 weeks of distal radius volar plate fixation.

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