title: Comparison of depressive symptoms during the early recovery period in patients with a distal radius fracture treated by volar plating and cast immobilisation.
abstract: BACKGROUND
  Patients with orthopaedic trauma experience substantial psychological and physical morbidities. The purpose of this study was to assess depressive symptoms in patients with a distal radius fracture, and to determine whether early use of the wrist after volar plating reduces depressive symptoms as compared with cast immobilisation during the early recovery period.
  
  
  METHODS
  Twenty-six patients with a distal radius fracture, who underwent volar plating and were allowed immediate use of the wrist, and 24 patients treated by cast immobilisation for 6 weeks were prospectively compared with respect to depressive symptoms at week 0, and at 2, 6, 12 and 24 weeks after injury, using the Center for Epidemiologic Studies Depression Scale (CES-D). Physical morbidity was assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and a pain Numerical Rating Scale (NRS). Multivariate analysis was performed to identify factors that independently predicted CES-D scores at each time point.
  
  
  RESULTS
  No differences in the CES-D scores were found between the volar plating and the cast immobilisation groups, although volar plating group had marginally better CES-D scores at 24 weeks. Multivariate analysis indicated that CES-D scores at each time were independently associated with pain NRS scores at 0 and 24 weeks, and DASH scores at 6 weeks.
  
  
  CONCLUSIONS
  Early use of the wrist after volar plating was not found to reduce depressive symptoms as compared with cast immobilisation in the early treatment period following a distal radius fracture. Pain was found to be an important predictor of depression, suggesting that caution is needed to address pain during the early rehabilitation period.
authors.affiliation: Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Goomi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea. hsgong@snu.ac.kr
authors.forename: Hyun Sik
authors.initials: HS
authors.lastname: Gong
authors.forename: Joon Oh
authors.initials: JO
authors.lastname: Lee
authors.forename: Jung Kyu
authors.initials: JK
authors.lastname: Huh
authors.forename: Joo Han
authors.initials: JH
authors.lastname: Oh
authors.forename: Sae Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Goo Hyun
authors.initials: GH
authors.lastname: Baek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D002370:Casts, Surgical; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology*; D004185:Disability Evaluation; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010146:Pain / Q000453:epidemiology* / Q000523:psychology; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D011885:Radius Fractures / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013997:Time Factors; D055815:Young Adult