J Wrist Surg 2020; 09(04): 298-303
DOI: 10.1055/s-0040-1709189
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Predictive Factors for Return to Driving following Volar Plate Fixation of Distal Radius Fracture

1   Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
1   Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
1   Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
Christopher Jones
1   Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
1   Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
1   Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
1   Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
1   Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
1   Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
Mark Wang
1   Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
,
1   Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
› Author Affiliations
Funding None.
Further Information

Publication History

24 September 2019

27 February 2020

Publication Date:
17 April 2020 (online)

Abstract

Background A common query by patients undergoing distal radius fracture (DRF) repair is when (s)he can resume driving postoperatively. A prospective cohort analysis was performed to assess fracture and patient factors on a patient's self-reported ability to return to driving to better inform patients and surgeons.

Methods Consecutive patients undergoing DRF repair with locking volar plate were enrolled. Preoperative demographic and radiographic characteristics, and postoperative time to return to driving were collected. Data collected included age, sex, hand dominance, body mass index (BMI), level of education, concomitant ulnar fracture, fracture setting prior to surgery, and AO fracture classification.

Results A total of 131 patients were enrolled (108 women, 23 men) with 36 AO type A, 22 AO type B, and 73 AO type C DRFs, with an average age of 59.5 years. Fracture severity by classification did not significantly affect time to return to driving. However, BMI, sex, and age were found to significantly affect time to return to driving. Patients aged 19 to 59 years, 60 to 75 years, and over 75 years returned to driving 13.1, 15.4, and 30.1 days following surgery, respectively (p < 0.01). Classified by BMI, patients that were normal weight, overweight, and obese returned to driving 11.5, 13.1, and 21.0 days following surgery, respectively (p < 0.05). Men returned to driving 8.8 days and women 17.3 days postoperatively (p = 0.001).

Conclusion Patients severity of fracture as determined by AO fracture type did not affect time to driving, while increased BMI, female sex, and increased age were found to be significant factors in patients' return to driving time after distal radius fracture repair.

Level of Evidence This is a Level II, prospective cohort study.

Ethical Approval

This study was approved by our institutional review board.


All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.


 
  • References

  • 1 Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am 2001; 26 (05) 908-915
  • 2 Mattila VM, Huttunen TT, Sillanpää P, Niemi S, Pihlajamäki H, Kannus P. Significant change in the surgical treatment of distal radius fractures: a nationwide study between 1998 and 2008 in Finland. J Trauma 2011; 71 (04) 939-942 , discussion 942–943
  • 3 Mellstrand-Navarro C, Pettersson HJ, Tornqvist H, Ponzer S. The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study. Bone Joint J 2014; 96-B (07) 963-969
  • 4 Melton III LJ, Amadio PC, Crowson CS, O'Fallon WM. Long-term trends in the incidence of distal forearm fractures. Osteoporos Int 1998; 8 (04) 341-348
  • 5 O'Neill TW, Cooper C, Finn JD. , et al; UK Colles' Fracture Study Group. Incidence of distal forearm fracture in British men and women. Osteoporos Int 2001; 12 (07) 555-558
  • 6 Koval KJ, Harrast JJ, Anglen JO, Weinstein JN. Fractures of the distal part of the radius. The evolution of practice over time. Where's the evidence?. J Bone Joint Surg Am 2008; 90 (09) 1855-1861
  • 7 Phadnis J, Trompeter A, Gallagher K, Bradshaw L, Elliott DS, Newman KJ. Mid-term functional outcome after the internal fixation of distal radius fractures. J Orthop Surg Res 2012; 7: 4
  • 8 Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am 2006; 31 (03) 359-365
  • 9 Ring D, Jupiter JB. Treatment of osteoporotic distal radius fractures. Osteoporos Int 2005; 16 (Suppl. 02) S80-S84
  • 10 Karantana A, Downing ND, Forward DP. , et al. Surgical treatment of distal radial fractures with a volar locking plate versus conventional percutaneous methods: a randomized controlled trial. J Bone Joint Surg Am 2013; 95 (19) 1737-1744
  • 11 Jones CM, Ramsey RW, Ilyas A. , et al. Safe return to driving after volar plating of distal radius fractures. J Hand Surg Am 2017; 42 (09) 700-704.e2
  • 12 Hickey S, Rodgers J, Wollstein R. Barriers to adherence with post-operative hand therapy following surgery for fracture of the distal radius. J Hand Microsurg 2015; 7 (01) 55-60
  • 13 Beard JR, Officer A, de Carvalho IA. , et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet 2016; 387 (10033): 2145-2154
  • 14 Drobetz H, Koval L, Weninger P. , et al. Volar locking distal radius plates show better short-term results than other treatment options: a prospective randomised controlled trial. World J Orthop 2016; 7 (10) 687-694
  • 15 Jose A, Suranigi SM, Deniese PN, Babu AT, Rengasamy K, Najimudeen S. Unstable distal radius fractures treated by volar locking anatomical plates. J Clin Diagn Res 2017; 11 (01) RC04-RC08
  • 16 Bolmers A, Luiten WE, Doornberg JN. , et al. A comparison of the long-term outcome of partial articular (AO Type B) and complete articular (AO Type C) distal radius fractures. J Hand Surg Am 2013; 38 (04) 753-759
  • 17 Plant CE, Parsons NR, Costa ML. Do radiological and functional outcomes correlate for fractures of the distal radius?. Bone Joint J 2017; 99-B (03) 376-382
  • 18 Roh YH, Lee BK, Noh JH, Oh JH, Gong HS, Baek GH. Factors delaying recovery after volar plate fixation of distal radius fractures. J Hand Surg Am 2014; 39 (08) 1465-1470
  • 19 Chung KC, Kotsis SV, Kim HM. Predictors of functional outcomes after surgical treatment of distal radius fractures. J Hand Surg Am 2007; 32 (01) 76-83
  • 20 Lee SJ, Park JW, Kang BJ, Lee JI. Clinical and radiologic factors affecting functional outcomes after volar locking plate fixation of dorsal angulated distal radius fractures. J Orthop Sci 2016; 21 (05) 619-624
  • 21 Mulders MAM, Fuhri Snethlage LJ, de Muinck Keizer RO, Goslings JC, Schep NWL. Functional outcomes of distal radius fractures with and without ulnar styloid fractures: a meta-analysis. J Hand Surg Eur Vol 2018; 43 (02) 150-157
  • 22 Yuan C, Zhang H, Liu H, Gu J. Does concomitant ulnar styloid fracture and distal radius fracture portend poorer outcomes? A meta-analysis of comparative studies. Injury 2017; 48 (11) 2575-2581
  • 23 Chung JO, Cho DH, Chung DJ, Chung MY. Associations among body mass index, insulin resistance, and pancreatic β-cell function in Korean patients with new-onset type 2 diabetes. Korean J Intern Med (Korean Assoc Intern Med) 2012; 27 (01) 66-71
  • 24 Truong JL, Doherty C, Suh N. The effect of socioeconomic factors on outcomes of distal radius fractures: a systematic review. Hand (N Y) 2018; 13 (05) 509-515
  • 25 Sandvall BK, Friedrich JB. Driving with upper extremity immobilization: a comprehensive review. J Hand Surg Am 2015; 40 (05) 1042-1047
  • 26 Chen V, Chacko AT, Costello FV, Desrosiers N, Appleton P, Rodriguez EK. Driving after musculoskeletal injury. Addressing patient and surgeon concerns in an urban orthopaedic practice. J Bone Joint Surg Am 2008; 90 (12) 2791-2797
  • 27 United States National Highway Traffic Safety Administration, American Medical Association. Physician's Guide to Assessing and Counseling Older Drivers. 2nd ed. Washington, DC: U.S. Dept. of Transportation, American Medical Association; 2010
  • 28 MacLeod K, Lingham A, Chatha H. , et al. “When can I return to driving?”: a review of the current literature on returning to driving after lower limb injury or arthroplasty. Bone Joint J 2013; 95-B (03) 290-294
  • 29 Nuñez VA, Giddins GEB. “Doctor, when can I drive?”: an update on the medico-legal aspects of driving following an injury or operation. Injury 2004; 35 (09) 888-890
  • 30 Chong PY, Golinvaux NS, Lee DH. Upper extremity immobilization and driving: limitations and liability. J Am Acad Orthop Surg 2019; 27 (14) e641-e647