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Utility of Radiographic Parameters in predicting Mid-Term PROMIS Upper Extremity Scores in Operatively Treated Distal Radius Fractures
Walter D. Sobba, BS
1; Gerardo Sanchez-Navarro, BS
2; Jacques H. Hacquebord, MD
2; Michael Fitzgerald, MD
1; Ren Peter, BS
2; De Souza Daniel, BS
11NYU Langone Health, New York, NY; 2New York University Langone Orthopedic Hospital, New York, NY
Introduction: In operatively treated distal radius fractures (DRF), it remains poorly understood the degree by which patient satisfaction correlates with post operative radiographic parameters, patient demographics, or comorbidities. This study aims to investigate the prognostic value of various radiographic, demographic, and comorbid factors on scores of the National Institutes of Health's Patient-Reported Outcomes Measurement Information System Upper Extremity Function (PROMIS UE) following DRF treatment. We hypothesize that radiographic parameters will not be strongly associated with patient-reported function.
Methods: A retrospective review of prospectively collected PROMIS UE scores in patients undergoing operative fixation for acute DRF between January 2016 and November 2022 was undertaken. Subjects were included if they sustained an isolated DRF with or without concurrent ulnar styloid fracture and had 6-month follow-up PROs and radiographs. Independent variables were patient baseline demographic information, comorbidities, AO/OTA fracture classification, perioperative information, and surgical outcome data including radiographic parameters following surgery. The primary outcome measure was prospectively collected, retrospectively reviewed PROMIS UE scores at minimum 6 months follow-up. Stepwise and conventional multivariate linear regression was used to analyze associations between non-radiographic and radiographic parameters with PROs, respectively. We performed a sub-analysis of radiographic parameters with patients above and below the median age of our cohort.
Results: In total, 192 patients met inclusion criteria for this study with a median follow-up of 328 days (182-2070). Stepwise analysis of non-radiographic parameters revealed each decade increase in patient age was associated with a 1.1-point decrease in PROMIS UE score (p=0.023), while use of a dorsal plate (N=5) was associated with a 9.6-point increase in PROMIS UE score compared to volar plating (N=177, p=0.022). Analysis of radiographic parameters among all patients demonstrated no association of PROMIS UE score with AO fracture classification or 6-month ulnar variance (p=0.400), volar tilt (median 3.90, [-45.5, 32.7], p=0.376), or radial inclination (median 22.1, [4.9, 41.0], p=0.870). A sub-analysis of patients above and below the median age of the cohort (61 years) revealed no associations between fracture pattern or radiographic parameters and PROMIS UE score.
Conclusions: We found no evidence to demonstrate a relationship between radiographic parameters following ORIF for distal radius fracture and patient function according to PROMIS scores. Initial fracture severity, similarly, did not predict mid-term patient reported function. These findings support the concept that obtaining a reduction within established acceptable radiographic parameters is essential for patient function.
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