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Long-term clinical and socio-economic outcomes following wrist fracture: a systematic review and meta-analysis

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Abstract

Summary

A comprehensive review of studies shows that patients with wrist fracture, aged over 50 years, experience pain and functional limitation long after fracture. This is associated with increased healthcare costs, and reduced quality of life. Understanding factors that predict poor outcomes is important for future healthcare policy and planning.

Purpose

To summarise and appraise evidence on the prognosis and long-term clinical and socio-economic outcomes following wrist fracture among adults aged 50 years and over.

Methods

Five databases (MEDLINE, EMBASE, AMED, CINAHL-P and PsycINFO) were comprehensively searched (supplemented by a grey-literature search) from inception till June 2021 for prospective/retrospective cohort studies of patients (≥ 50 years) with a history of wrist fracture and reporting long-term (≥ 6 months) outcomes. Peer study selection, data extraction and risk of bias assessment were conducted. A random effects meta-analysis was used to summarise estimates of pain and function outcomes.

Results

78 studies (n = 688,041 patients) were included. Patients report persistent moderate to severe pain (range: 7.5%-62%) and functional limitations (range: 5.5–78%) up to 12-months or later after wrist fracture. Mean Patient-Rated Wrist Evaluation (PRWE) score for pain and function (9 studies, n = 1759 patients) was 15.23 (95%CI 12.77, 17.69) at 6-months to 13-years follow-up. Mean disabilities of the arm, shoulder and hand (DASH) score (9 studies, n = 1346 patients) was 13.82 (95%CI 12.71, 14.93)( at 6- to 17-months follow-up. A 10–20% increase in healthcare encounters in the first 12-months after fracture was observed. Twelve prognostic factors were associated with poor long-term outcomes.

Conclusion

Evidence shows that a high proportion of people aged over 50 years with wrist fracture experience pain and functional limitation > 6 months after fracture. This is associated with increased healthcare costs, and reduced quality of life. Exploratory evidence was found for several candidate prognostic factors. Their predictive performance needs to be investigated further.

PROSPERO: CRD42018116478

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Acknowledgements

Authors acknowledge and are grateful for the contributions of Dr Linda Chesterton, Dr John Edwards and Mrs Victoria Jansen (Senior Hand and Research Physiotherapist, Pulvertaft Hand Centre, Royal Derby Hospital) who contributed to the development and design of this study. We also acknowledge contributions of Mrs Ruth Haines (Patient and Public Involvement and Engagement) in the study design and interpretation of results as part of this study.

Funding

This study is funded by the National Institute for Health Research (NIHR) (PB-PG-0317–10033)/Research for Patient Benefit. ZP is funded by the NIHR, Clinician Scientist Award (ZP—CS-2018–18-ST2-010)/NIHR Academy. CB is funded by an NIHR Clinical Lectureship. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR or the Department of Health and Social Care.

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  1. Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK

    O. O. Babatunde, M. Bucknall, C. Burton, N. Corp, Z. Paskins & D. A. van der Windt

  2. Centre for Health and Development, Staffordshire University, Stoke-on-Trent, ST4 2DF, UK

    J. J. Forsyth

  3. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK

    S. Gwilym

  4. Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, ST6 7AG, UK

    Z. Paskins

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Babatunde, O.O., Bucknall, M., Burton, C. et al. Long-term clinical and socio-economic outcomes following wrist fracture: a systematic review and meta-analysis. Osteoporos Int 33, 753–782 (2022). https://doi.org/10.1007/s00198-021-06214-9

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