Long-term functional outcome of distal radius fractures is associated with early post-fracture bone stiffness of the fracture region: An HR-pQCT exploratory study

Bone. 2019 Oct:127:510-516. doi: 10.1016/j.bone.2019.06.013. Epub 2019 Jun 19.

Abstract

Identifying determinants of long-term functional outcome after a distal radius fracture is challenging. Previously, we reported on the association between early HR-pQCT measurements and clinical outcome 12 weeks after a conservatively treated distal radius fracture. We extended the follow-up and assessed functional outcome after two years in relation to early HR-pQCT derived bone parameters. HR-pQCT scans of the fracture region were performed in 15 postmenopausal women with a distal radius fracture at 1-2 (baseline), 3-4 weeks and 26 months post-fracture. Additionally, the contralateral distal radius was scanned at baseline. Bone density, micro-architecture parameters and bone stiffness using micro-finite element analysis (μFEA) were evaluated. During all visits, wrist pain and function were assessed using the patient-rated wrist evaluation questionnaire (PRWE), quantifying functional outcome with a score between 0 and 100. Two-year PRWE was associated with torsional and bending stiffness 3-4 weeks post-fracture (R2: 0.49, p = 0.006 and R2: 0.54, p = 0.003, respectively). In contrast, early micro-architecture parameters of the fracture region or contralateral bone parameters did not show any association with long-term outcome. This exploratory study indicates that HR-pQCT with μFEA performed within four weeks after a distal radius fracture captures biomechanical fracture characteristics that are associated with long-term functional outcome and therefore could be a valuable early outcome measure in clinical trials and clinical practice.

Keywords: Finite element analysis; Fracture healing; Functional outcome; HR-pQCT.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomechanical Phenomena
  • Disability Evaluation
  • Female
  • Humans
  • Middle Aged
  • Pain / etiology
  • Radius / diagnostic imaging*
  • Radius / physiopathology*
  • Radius Fractures / complications
  • Radius Fractures / diagnostic imaging*
  • Radius Fractures / physiopathology*
  • Time Factors
  • Tomography, X-Ray Computed*