Comparison of 24-Month Outcomes After Treatment for Distal Radius Fracture
Authors: Kevin C. Chung, Hyungjin Myra Kim, Sunitha Malay, Melissa J. Shauver, Steven C Haase, Jeffrey N Lawton, John R Lien, Adeyiza O Momoh, Kagan Ozer, Erika D Sears, Jennifer F Waljee, Matthew s Brown, Hoyune E Cho, Brett F MIchelotti, Tamara D Rozental, Paul T. Appleton, Edward K Rodriguez, Laura N. Deschamps, Lindsay Mattfolk, Katiri Wagner, Philip Blazar, Brandon E Earp, Emerson Floyd, Dexter L Louie, Fraser J. Leversedge, Marc J. Richard, David S Ruch, Suzanne Finley, Cameron Howe, Maria Manson, Janna Whitfield, Bertrand Perey, Kelly Apostle, Dory Boyer, Farhad Moola, Trevor Stone, Darous Viskontas, Mauri Zomar, Karyn Moon, Raely Moon, Loree K Kalliainen, Christina M Ward, James W Fletcher, Cherrie A Heinrich, Katharine S Pico, Ashish Y. Mahajan, Brian W Hill, Sandy Vang, Dawn M Laporte, Erik A Hasenboehler, Scott D Lifchez, Greg M Osgood, Babar Shafiq, Jaimie T Shores, Vaishali Laljani, Brent H Bamberger, Timothy W Harman, David W Martineau, Carla Robinson, Brandi Palmer, Ruby Grewal, Ken A Faber, Joy C MacDermid, Kate Kelly, Katrina Munro, Joshua I Vincent, David Ring, Jesse B Jupiter, Jilian S Gruber, Abigail Finger, Rakesh K Reddy, Taylor M Pong, Emily Thornton, David G Dennison, Sanjeev Kakar, Marco Rizzo, Alexander Y Shin, Tyson L Scrabeck, Kyle Chepla, Kevin Malone, Harry A Hoyen, Blaine Todd Bafus, Roderick B Jordan, Bram Kaufman, Ali Totonchil, Dana R Hromyak, Lisa Humbert, Sandeep Sebastin, Sally Tay, Kate W Nellans, Sara L Merwin, Ethan W Blackburn, Sandra J Hanlin, Barbara Patterson, Glenn R Gaston, Christopher R Chadderdon, Erika G Gantt, John S Gaul, Daniel R Lewis, Bryan J Leffler, Lois K Osier, Paul C Perlik, Alan W Ward, Tod A Clark, Sheila McRae, Jennifer M Wolf, Craig M Rodner, Katy Coyle, Thomas P Lehman, Yuri C Lansinger, Gavin D O’Mahony, Kathy Carl, Janet Wells, David J Bozentka, Scott L Levin, David P Steinberg, Robert Goitz, Annamarie D Horan, Denise Knox, Kara Napolitano, Cathy A Naccarelli, Joelle Tighe, Warren C Hammert, Allison W McIntyre, Krista L Noble, Kaili Waldrick, Jeffrey B Friedrich, David Bowman, Angela Wilson, Zhongyu LI, Andrew L Koman, Benjamin R Graves, Beth P Smith, Debra Bullard
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Distal radius fractures (DRFs) are common injuries among older adults and can result in substantial disability. Current evidence regarding long-term outcomes in older adults is scarce. <h3>Objective</h3> To compare outcomes across treatment groups at 24 months among adults with DRFs who participated in the WRIST trial. <h3>Design, Setting, and Participants</h3> The Wrist and Radius Injury Surgical Trial (WRIST) randomized, international, multicenter trial was conducted from April 1, 2012, through December 31, 2016. Participants were adults aged 60 years or older with isolated, unstable DRFs at 24 health systems in the US, Canada, and Singapore. Data analysis was performed from March 2019 to March 2021. <h3>Interventions</h3> Participants were randomized to open reduction and volar locking plate system (VLPS), external fixation with or without supplementary pinning (EFP), and percutaneous pinning (CRPP). The remaining participants chose closed reduction and casting. <h3>Main Outcomes and Measures</h3> The primary outcome was the 24-month Michigan Hand Outcomes Questionnaire (MHQ) summary score. Secondary outcomes were scores on the MHQ subdomains hand strength and wrist motion. <h3>Results</h3> A total of 304 adults were recruited for the study, and 187 were randomized to undergo surgery, 65 to VLPS, 64 to EFP, and 58 to CRPP; 117 participants opted for closed reduction and casting. Assessments were completed at 24 months for 182 participants (160 women [87.9%]; mean [SD] age, 70.1 [8.5] years). Mean MHQ summary scores at 24 months were 88 (95% CI, 83-92) for VLPS, 83 (95% CI, 78-88) for EFP, 85 (95% CI, 79-90) for CRPP, and 85 (95% CI, 79-90) for casting, with no clinically meaningful difference across groups after adjusting for covariates (χ<sup>2</sup><sub>3</sub> = 1.44;<i>P</i> = .70). Pain scores also did not differ across groups at 24 months (χ<sup>2</sup><sub>3</sub> = 2.64;<i>P</i> = .45). MHQ summary scores changed from 82 (95% CI, 80-85) to 85 (95% CI, 83-88) (<i>P</i> = .12) between 12 and 24 months across groups. The rate of malunion was higher in the casting group (26 participants [59.1%]) than in the other groups (4 participants [8.0%] for VLPS, 8 participants [17.0%] for EFP, and 4 participants [9.8%] for CRPP; χ<sup>2</sup><sub>3</sub> = 43.6;<i>P</i> &lt; .001), but malunion was not associated with the 24-month outcome difference across groups. <h3>Conclusions and Relevance</h3> The study did not find clinically meaningful patient-reported outcome differences 24 months after injury across treatment groups, with little change between 12 and 24 months. These findings suggest that long-term outcomes need not necessarily be considered in deciding between treatment options. Patient needs and recovery goals that fit to relative risks and benefits of each treatment type will be more valuable in treatment decision-making. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT01589692