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J Hand Surg Am. 2019 Sep;44(9):762-771. doi: 10.1016/j.jhsa.2019.05.016. Epub 2019 Jul 23.

Predicting Outcomes After Distal Radius Fracture: A 24-Center International Clinical Trial of Older Adults.

Collaborators (138)

Chung KC, Kim HM, Haase SC, Lawton JN, Lien JR, Momoh AO, Ozer K, Sears ED, Waljee JF, Brown MS, Cho HE, Michelotti BF, Malay S, Shauver MJ, Rozental TD, Appleton PT, Rodriguez EK, Deschamps LN, Mattfolk L, Wagner K, Blazar P, Earp BE, Floyd WE, Louie DL, Leversedge FJ, Richard MJ, Ruch DS, Finley S, Howe C, Manson M, Whitfield J, Perey BH, Apostle K, Boyer D, Moola F, Stone T, Viskontas D, Zomar M, Moon K, Moon R, Kalliainen LK, Ward CM, Fletcher JW, Heinrich CA, Pico KS, Mahajan AY, Hill BW, Vang S, Laporte DM, Hasenboehler EA, Lifchez SD, Osgood GM, Shafiq B, Shores JT, Laljani V, Bamberger HB, Harman TW, Martineau DW, Robinson C, Palmer B, Grewal R, Faber KA, MacDermid JC, Kelly K, Munro K, Vincent JI, Ring D, Jupiter JB, Finger A, Gruber JS, Reddy RK, Pong TM, Thornton ER, Dennison DG, Kakar S, Rizzo M, Shin AY, Scrabeck TL, Chepla K, Malone K, Hoyen HA, Bafus BT, Jordan RB, Kaufman B, Totonchil A, Hromyak DR, Humbert L, Sebastin S, Tay S, Nellans KW, Merwin SL, Blackburn EW, Hanlin SJ, Patterson B, Gaston RG, Cadderdon RC, Gantt EG, Gaul JS, Lewis DR, Loeffler BJ, Osier LK, Perlik PC, Ward WA, Connell B, Haug P, Michalek C, Clark TA, McRae S, Wolf JM, Rodner CM, Coyle K, Lehman TP, Lansinger YC, O'Mahony GD, Carl K, Wells J, Bozentka DJ, Levin LS, Steinberg DP, Horan AD, Knox D, Napolitano K, Fowler J, Goitz R, Naccarelli CA, Tighe J, Hammert WC, McIntyre AW, Noble KL, Waldrick K, Friedrich JB, Bowman D, Wilson A, Li Z, Koman LA, Graves BR, Smith BP, Bullard D.

Author information

Section of Plastic Surgery, Department of Surgery. Electronic address:
Center for Statistical Consulting and Research.
Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.



Current evidence on predictors of outcomes after distal radius fracture is often based on retrospective analyses or may be confounded by fracture type. Using data from the Wrist and Radius Injury Surgical Trial (WRIST), a 24-site randomized study of distal radius fracture treatment, in which all fractures are severe enough to warrant surgery, we set out to perform a secondary data analysis to explore predictors of better or worse hand outcomes.


The primary outcome measure was the Michigan Hand Outcomes Questionnaire (MHQ) summary score 12 months after treatment. We used a regression tree analysis with recursive partitioning to identify subgroups of participants who experienced similar outcomes (ie, MHQ score) and to determine which baseline or treatment factors they had in common.


Factors most predictive of 12-month MHQ score were pain at enrollment, education, age, and number of comorbidities. Specifically, participants who had a high school education or less and also reported severe pain had the lowest MHQ scores. Conversely, participants with less pain and more education and who were age 87 years or younger with one or no comorbid condition had the highest MHQ scores. Treatment type or radiographic measurements assessed on post-reduction films did not affect 12-month outcomes.


These results identified patient characteristics that can be used by surgeons to identify subgroups of patients who may experience similar hand outcomes.


Prognostic III.


Distal radius fracture; older adults; predictors of outcomes


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