Abramo, A, MD, Kopylov, P, MD, Tagil, M, MD

Background and purpose: Distal radius fractures are most often treated nonoperatively, but sometimes they are treated surgically when deemed unstable. Based on the literature, a consensus protocol for treatment has been developed in southern Sweden to aid clinicians in their decision making. We evaluated the restults of this protocol prospectively using a validated outcome instrument (DASH) in a large consecutive and population based series of unsettled patients.

Methods: 581 patients were treated according the protocol. Age, sex, fracture side, and type of treatment were registered. The subjective outcome was measured by DASH. 133 patients were operated.

Results: 75% of the patients returned the questionnare. The median DASH score at 3 months was 18.3 and at 12 months it was 7.5. All treatment groups had low DASH scores at the final follow-up. Reduced, nonoperated fractures had a worse score (11.6) than undisplaced (4.2) or operated fractures (6.0). Age was the only other predictor, with older patients having a worse score. A correlation was found between the short-version 110item QuickDASH questionnaire and the full 30-item DASH, both at 3 months (r = 0.98) and at 1 year (r=0.97) (p,0.001 for both).

Interpretation: Most patients have residual symptoms at 3 months after the fracture but are normalized at 1 year. Good final subjective result was achieved with the proposed protocol regardless of initial severity and treatent of the fracture, as indicated by a low median DASH score in all groups. There was a correlation between QuickDASH and the full DASH, and the former could be used in future studies.