{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T09:14:52Z","timestamp":1792746892222,"version":"4.5.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,4,18]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The long-term effect of distal radial fracture malunion on activity limitations is unknown. Between 2001 and 2002, we conducted a prospective cohort study of all patients with distal radial fracture treated with casting or percutaneous fixation in northeast Scania in Sweden. In that original study, the patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at baseline and at 2 years. We performed a long-term follow-up study of patients who were 18 to 65 years of age at the time of the fracture to investigate the association between fracture malunion and activity limitations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this long-term follow-up, patients who had participated in the original study completed the DASH questionnaire and a visual analog scale (VAS) for pain and for satisfaction (scored, 0 [best] to 100) and underwent radiographic and physical examinations at 12 to 14 years after the fracture. We defined malunion as dorsal angulation of \u226510\u00b0, ulnar variance of \u22653 mm, and\/or radial inclination of \u226415\u00b0. We also assessed the presence of radiocarpal osteoarthritis and ulnar styloid nonunion. The primary outcome was the change in DASH score from baseline. Secondary outcomes were DASH, pain, and satisfaction scores, wrist range of motion, and grip strength at the time of the follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 85 eligible patients, 63 (74%) responded to the questionnaires and underwent examinations. Malunion was found in 25 patients, osteoarthritis was found in 38 patients, and styloid nonunion was found in 9 patients. Compared with patients without malunion, those with malunion had significantly worse DASH scores from baseline to 12 to 14 years (p = 0.002); the adjusted mean difference was 11 points (95% confidence interval [CI], 4 to 17 points). Similarly, follow-up scores were significantly worse among patients with malunion; the adjusted mean difference was 14 points (95% CI, 7 to 22 points; p &lt; 0.001) for DASH scores, 10 points (95% CI, 0 to 20 points; p = 0.049) for VAS pain scores, and 26 points (95% CI, 11 to 41 points; p = 0.001) for VAS satisfaction scores. No differences were found in range of motion or grip strength. Osteoarthritis (mostly mild) and styloid nonunion had no significant association (p &gt; 0.05) with DASH scores, VAS pain or satisfaction scores, or grip strength.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Patients who sustain a distal radial fracture at the age of 18 to 65 years and develop malunion are more likely to have worse long-term outcomes including activity limitations and pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.17.00107","type":"journal-article","created":{"date-parts":[[2018,4,18]],"date-time":"2018-04-18T19:59:55Z","timestamp":1524081595000},"page":"633-639","source":"Crossref","is-referenced-by-count":40,"title":["Association Between Distal Radial Fracture Malunion and Patient-Reported Activity Limitations"],"prefix":"10.2106","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1023-712X","authenticated-orcid":false,"given":"Muhanned","family":"Ali","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Kristianstad and H\u00e4ssleholm Hospitals, H\u00e4ssleholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Brogren","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Sk\u00e5ne University Hospital, Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Wagner","sequence":"additional","affiliation":[{"name":"Centre for Clinical Research, Uppsala University, V\u00e4stmanland County Hospital, V\u00e4ster\u00e5s, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isam","family":"Atroshi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Kristianstad and H\u00e4ssleholm Hospitals, H\u00e4ssleholm, Sweden"},{"name":"Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"9","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.1007\/s11136-013-0391-z","article-title":"Health status and (health-related) quality of life during the recovery of distal radius fractures: a systematic review","volume":"22","author":"Van Son","year":"2013","journal-title":"Qual Life Res."},{"issue":"2","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"218","DOI":"10.3122\/jabfm.2016.02.150233","article-title":"Lack of agreement on distal radius fracture treatment","volume":"29","author":"Bruce","year":"2016","journal-title":"J Am Board Fam Med."},{"issue":"5","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1007\/s11999-012-2767-8","article-title":"Distal radius malunion increases risk of persistent disability 2 years after fracture: a prospective cohort study","volume":"471","author":"Brogren","year":"2013","journal-title":"Clin Orthop Relat Res."},{"issue":"9","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1471-2474-12-9","article-title":"Relationship between distal radius fracture malunion and arm-related disability: a prospective population-based cohort study with 1-year follow-up","volume":"12","author":"Brogren","year":"2011","journal-title":"BMC Musculoskelet Disord."},{"issue":"3","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1080\/17453670710015283","article-title":"Evaluation of a treatment protocol in distal radius fractures: a prospective study in 581 patients using DASH as outcome","volume":"79","author":"Abramo","year":"2008","journal-title":"Acta Orthop."},{"issue":"6","key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1002\/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L","article-title":"The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder and Hand) [corrected]","volume":"29","author":"Hudak","year":"1996","journal-title":"Am J Ind Med."},{"issue":"6","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1080\/000164700317362262","article-title":"The Disabilities of the Arm, Shoulder and Hand (DASH) outcome questionnaire: reliability and validity of the Swedish version evaluated in 176 patients","volume":"71","author":"Atroshi","year":"2000","journal-title":"Acta Orthop Scand."},{"issue":"6","key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"512","DOI":"10.2106\/JBJS.16.00733","article-title":"Efficacy of surgical-site, multimodal drug injection following operative management of femoral fractures: a randomized controlled trial","volume":"99","author":"Koehler","year":"2017","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib9-20230810","doi-asserted-by":"crossref","first-page":"638","DOI":"10.2106\/JBJS.16.00366","article-title":"Prognostic factors affecting union after ulnar shortening osteotomy in ulnar impaction syndrome: a retrospective case-control study","volume":"99","author":"Cha","year":"2017","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib10-20230810","doi-asserted-by":"crossref","first-page":"128","DOI":"10.3109\/17453674.2014.887951","article-title":"A simple visual analog scale for pain is as responsive as the WOMAC, the SF-36, and the EQ-5D in measuring outcomes of revision hip arthroplasty","volume":"85","author":"Zampelis","year":"2014","journal-title":"Acta Orthop."},{"issue":"11","key":"bib11-20230810","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1471-2474-4-11","article-title":"The Disabilities of the Arm, Shoulder and Hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery","volume":"4","author":"Gummesson","year":"2003","journal-title":"BMC Musculoskelet Disord."},{"issue":"1","key":"bib12-20230810","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1148\/radiology.219.1.r01ap1311","article-title":"Wrist fractures: what the clinician wants to know","volume":"219","author":"Goldfarb","year":"2001","journal-title":"Radiology."},{"issue":"4","key":"bib13-20230810","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/0363-5023(89)90175-5","article-title":"Measuring ulnar variance: a comparison of techniques","volume":"14","author":"Steyers","year":"1989","journal-title":"J Hand Surg Am."},{"issue":"4","key":"bib14-20230810","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1136\/ard.16.4.494","article-title":"Radiological assessment of osteo-arthrosis","volume":"16","author":"Kellgren","year":"1957","journal-title":"Ann Rheum Dis."},{"issue":"7","key":"bib15-20230810","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1016\/j.jhsa.2007.05.009","article-title":"The risk of adverse outcomes in extra-articular distal radius fractures is increased with malalignment in patients of all ages but mitigated in older patients","volume":"32","author":"Grewal","year":"2007","journal-title":"J Hand Surg Am."},{"issue":"6","key":"bib16-20230810","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1054\/jhsb.2000.0373","article-title":"Outcome of distal radial fractures in young adults","volume":"25","author":"Gliatis","year":"2000","journal-title":"J Hand Surg Br."},{"issue":"4","key":"bib17-20230810","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1302\/0301-620X.70B4.3403617","article-title":"Colles fracture: does the anatomical result affect the final function?","volume":"70","author":"McQueen","year":"1988","journal-title":"J Bone Joint Surg Br."},{"issue":"3","key":"bib18-20230810","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1177\/1753193408087092","article-title":"Complex articular fractures of the distal radius: the role of closed reduction and external fixation","volume":"33","author":"Bini","year":"2008","journal-title":"J Hand Surg Eur Vol."},{"issue":"10 Suppl","key":"bib19-20230810","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/00005131-200711101-00001","article-title":"Fracture and dislocation classification compendium \u2013 2007: Orthopaedic Trauma Association Classification, Database and Outcomes Committee","volume":"21","author":"Marsh","year":"2007","journal-title":"J Orthop Trauma."},{"issue":"9","key":"bib20-20230810","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.2106\/JBJS.G.01569","article-title":"Fractures of the distal part of the radius. The evolution of practice over time. Where\u2019s the evidence?","volume":"90","author":"Koval","year":"2008","journal-title":"J Bone Joint Surg Am."},{"key":"bib21-20230810","first-page":"CD006194","article-title":"External fixation versus conservative treatment for distal radial fractures in adults","volume":"3","author":"Handoll","year":"2007","journal-title":"Cochrane Database Syst Rev."},{"issue":"9","key":"bib22-20230810","first-page":"1944","article-title":"Prediction of instability in distal radial fractures","volume":"88","author":"Mackenney","year":"2006","journal-title":"J Bone Joint Surg Am."},{"issue":"9","key":"bib23-20230810","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/j.jhsa.2007.08.019","article-title":"Long-term outcome of nonsurgically treated distal radius fractures","volume":"32","author":"F\u00f6ldhazy","year":"2007","journal-title":"J Hand Surg Am."},{"issue":"1","key":"bib24-20230810","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.jhsa.2006.10.010","article-title":"Predictors of functional outcomes after surgical treatment of distal radius fractures","volume":"32","author":"Chung","year":"2007","journal-title":"J Hand Surg Am."},{"issue":"9","key":"bib25-20230810","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.2106\/00004623-199709000-00003","article-title":"Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation","volume":"79","author":"Catalano","year":"1997","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib26-20230810","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.jhsa.2006.01.008","article-title":"Fifteen-year outcome of displaced intra-articular fractures of the distal radius","volume":"31","author":"Goldfarb","year":"2006","journal-title":"J Hand Surg Am."},{"issue":"5","key":"bib27-20230810","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1302\/0301-620X.90B5.19448","article-title":"Do young patients with malunited fractures of the distal radius inevitably develop symptomatic post-traumatic osteoarthritis?","volume":"90","author":"Forward","year":"2008","journal-title":"J Bone Joint Surg Br."},{"issue":"5","key":"bib28-20230810","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.2106\/JBJS.I.00737","article-title":"Quality of life after volar plate fixation of articular fractures of the distal part of the radius","volume":"92","author":"Gruber","year":"2010","journal-title":"J Bone Joint Surg Am."},{"issue":"10","key":"bib29-20230810","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1016\/j.jhsa.2014.05.032","article-title":"The effects of ulnar styloid fractures on patients sustaining distal radius fractures","volume":"39","author":"Daneshvar","year":"2014","journal-title":"J Hand Surg Am."},{"issue":"2","key":"bib30-20230810","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jhsa.2009.10.035","article-title":"Clinical impact of united versus nonunited fractures of the proximal half of the ulnar styloid following volar plate fixation of the distal radius","volume":"35","author":"Buijze","year":"2010","journal-title":"J Hand Surg Am."},{"issue":"12","key":"bib31-20230810","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1016\/j.injury.2014.08.007","article-title":"Ulnar styloid process nonunion and outcome in patients with a distal radius fracture: a meta-analysis of comparative clinical trials","volume":"45","author":"Wijffels","year":"2014","journal-title":"Injury."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201804180-00001","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:42:57Z","timestamp":1787751777000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201804180-00001"}},"subtitle":["A Long-Term Follow-up"],"short-title":[],"issued":{"date-parts":[[2018,4,18]]},"references-count":31,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.17.00107","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,18]]}}}