title: The impact of patient activity level on wrist disability after distal radius malunion in older adults.
abstract: OBJECTIVE
  To determine if high-activity older adults are adversely affected by distal radius malunion.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Hand clinics at a tertiary institution.
  
  
  METHODS
  Ninety-six patients 60 years or older at the time of fracture were evaluated at least 1 year after distal radius fracture.
  
  
  METHODS
  Physical Activity Scale of the Elderly scores stratified participants into high- and low-activity groups. Malunions were defined radiographically by change of ≥20 degrees of lateral tilt, ≥15 degrees radial inclination, ≥4 mm of ulnar variance, or ≥4 mm intra-articular gap or step-off, compared with the uninjured wrist.
  
  
  METHODS
  Patient-rated disability of the upper extremity was measured by the QuickDASH and visual analog scales (VAS) for pain/function. Strength and motion measurements objectively quantified wrist function.
  
  
  RESULTS
  High-activity participants with a distal radius malunion were compared with high-activity participants with well-aligned fractures. There was no significant difference in QuickDASH scores, VAS function, strength, and wrist motion despite statistically, but not clinically, relevant increases in VAS pain scores (difference 0.5, P = 0.04) between the groups. Neither physical Activity Scale of the Elderly score (β = 0.001, 95% confidence interval: -0.002 to 0.004) nor malunion (β = 0.133, 95% confidence interval: -0.26 to 0.52) predicted QuickDASH scores in regression modeling after accounting for age, sex, and treatment. Operative management failed to improve outcomes and resulted in decreased grip strength (P = 0.05) and more frequent complications (26% vs. 7%, P = 0.01) when compared with nonoperative management.
  
  
  CONCLUSIONS
  Even among highly active older adults, distal radius malunion does not affect functional outcomes. Judicious use of operative management is warranted provided heightened complication rates.
  
  
  METHODS
  Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedics Surgery, Washington University School of Medicine in St Louis, St Louis, MO.
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Nelson
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Stepan
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Osei
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Calfee
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000175:diagnosis* / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008297:Male; D009043:Motor Activity; D011885:Radius Fractures / Q000175:diagnosis* / Q000534:rehabilitation / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000175:diagnosis* / Q000534:rehabilitation / Q000601:surgery