Modifiable Factors Associated With Chronic Pain 1 Year After Operative Management of Distal Radius Fractures: A Secondary Analysis of a Randomized Clinical Trial

Alfred P Yoon, Chang Wang, Kelly A Speth, Lu Wang, Kevin C Chung, WRIST Group, Alfred P Yoon, Chang Wang, Kelly A Speth, Lu Wang, Kevin C Chung, WRIST Group

Abstract

Importance: Despite appropriate treatment, many patients who sustain distal radius fractures (DRFs) report persistent wrist pain. Chronic musculoskeletal pain is among the leading health problems in the elderly population associated with significant personal and societal burden.

Objective: To identify modifiable preoperative factors that are significantly associated with developing chronic pain.

Design, setting, and participants: This is a secondary analysis of the Wrist and Radius Injury Surgical Trial (WRIST), a randomized multicenter clinical trial of 24 study sites in the United States, Canada, and Singapore that enrolled patients from April 10, 2012, to December 31, 2016. Adults older than 60 years who sustained closed extra-articular DRFs, were treated operatively, and completed 12-month Michigan Hand Outcomes Questionnaires (MHQs) were included in this study. Analysis was conducted from September to December 2019.

Interventions: Volar locking plate internal fixation, external fixation, or percutaneous pinning.

Main outcomes and measures: 12-month MHQ pain domain score. Inverse probability weighted logistic regression was used to identify factors associated with of chronic pain.

Results: A total of 146 patients with DRF who were treated operatively and had 12-month MHQ scores met inclusion criteria. The mean (SD) patient age was 68.9 (7.2) years, 128 (87.6%) were women, and 93 (63.7%) were retired. Chronic pain was present in 87 patients (59.6%) and absent in 59 patients (40.4%) at 1-year follow-up. A 1-week delay in surgery was associated with more than triple the odds of developing chronic pain (odds ratio [OR], 3.65; 95% CI, 1.48-9.00), and each 10-point increase in preoperative pain was associated with a 17% increase in the odds of experiencing chronic pain (OR, 1.17; 95% CI, 1.02-1.34). Internal fixation was associated with decreased odds of developing chronic pain compared with the other 2 procedures (OR, 0.29; 95% CI, 0.10-0.90).

Conclusions and relevance: In this study, preoperative pain, time to surgery, and procedure type were modifiable factors associated with chronic pain 1 year after DRF treated with surgery. Adequate pain control in patients with acute DRFs even before definitive surgical management and earlier fixation for patients requiring surgery may decrease the risk of developing chronic pain. Internal fixation may decrease the risk of chronic pain after DRF surgery, compared with percutaneous pinning or external fixation.

Trial registration: ClinicalTrials.gov Identifier: NCT01589692.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Chung reported receiving book royalties from Wolters Kluwer and Elsevier and serving as a consultant for Axogen. No other disclosures were reported.

Figures

Figure 1.. Flow Diagram of the Current…
Figure 1.. Flow Diagram of the Current Secondary Analysis Based on the Wrist and Radius Injury Surgical Trial (WRIST)
Figure 2.. Probability of Complete Data in…
Figure 2.. Probability of Complete Data in Patients With and Without 12-month MHQ Pain Scores
The distributions have substantial difference, indicating possible selection bias. However, the degree of overlap suggests potential for valid statistical analysis after adjustment. MHQ indicates Michigan Hand Outcomes Questionnaire.

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