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Distal Radius Fracture AO type C, Treatment and Outcome. An Observational Study of 12,199 Fractures from the National Swedish Fracture Register
Marcus Sagerfors, MD, PhD1, Hugo Jakobsson, MD2 and Per Wretenberg, MD, PhD1, (1)Orebro university, Orebro, Sweden, (2)Örebro University, Örebro, Sweden

Introduction: The distal radius fracture (DRF) is the most common fracture in the adult population. Optimal treatment is still controversial. In addition, there are often substantial differences between DRFs regarding trauma mechanism, treatment, functional demands and outcome. The aim of this study was to study epidemiology, treatment and outcome of AO type C fractures using data from a large national register study. A secondary aim was to investigate factors that may influence outcome.

Methods: We used prospectively collected data from the Swedish fracture register. All non-pathological AO type C distal radius fractures registered between April 2012 and December 2018 in patients were included.

Results
A total number of 12 199 cases with AO type C fracture were identified. AO type C1 fracture was most common with 5400 cases, followed by AO type C2 with 4304 and AO type C3 with 2495. Cast treatment and surgical treatment with volar locking plate fixation was most common, 6042 (49.5%) respectively 4325 (35.5%) patients. Less common methods were external fixation (0.6%), double plates (1.3%) and bridge plate (0.1%). AO type C1 fracture had the most favorable outcome regarding EQ-5D and SMFA-score, followed by AO type C2. In AO type C3 fractures, dorsal plating and external fixation were associated with an inferior hand/arm function index. In AO type C1 fractures K-wires was associated with an inferior SMFA bother index. Otherwise no differences were found between the treatment methods regarding patient-reported outcome. Patients <65 years of age treated with a volar plate reported inferior one-year outcome compared to cast treatment. Patients who, at the time of the fracture, did not expect a full recovery were more likely to have an inferior outcome one year after the fracture.

Discussion: This nationwide register study provides detailed data on AO type C DRFs regarding epidemiology, treatment and self-reported outcome. A good outcome fracture is possible, but many patients do not recover completely. Patients' expectations and psychological factors might influence the outcome. No treatment method was found superior.


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