Long-term functional outcome of distal radius fractures is associated with early post-fracture bone stiffness of the fracture region: An HR-pQCT exploratory study

• Published in: Bone (New York, N.Y.) N.Y.), 2019-10, Vol.127, p.510-516
• Main Authors: Heyer, F.L., de Jong, J.J.A., Willems, P.C., Arts, J.J., Bours, S.G.P., van Kuijk, S.M.J., Poeze, M., Geusens, P.P., van Rietbergen, B., van den Bergh, J.P.
• Format: Article
• Language: English
• Subjects: Finite element analysis; Fracture healing; Functional outcome; HR-pQCT
• ISSN: 8756-3282; 1873-2763
• DOI: 10.1016/j.bone.2019.06.013

Identifying determinants of long-term functional outcome after a distal radius fracture is challenging. Previously, we reported on the association between early HR-pQCT measurements and clinical outcome 12 weeks after a conservatively treated distal radius fracture. We extended the follow-up and assessed functional outcome after two years in relation to early HR-pQCT derived bone parameters. HR-pQCT scans of the fracture region were performed in 15 postmenopausal women with a distal radius fracture at 1–2 (baseline), 3–4 weeks and 26 months post-fracture. Additionally, the contralateral distal radius was scanned at baseline. Bone density, micro-architecture parameters and bone stiffness using micro-finite element analysis (μFEA) were evaluated. During all visits, wrist pain and function were assessed using the patient-rated wrist evaluation questionnaire (PRWE), quantifying functional outcome with a score between 0 and 100. Two-year PRWE was associated with torsional and bending stiffness 3–4 weeks post-fracture (R2: 0.49, p = 0.006 and R2: 0.54, p = 0.003, respectively). In contrast, early micro-architecture parameters of the fracture region or contralateral bone parameters did not show any association with long-term outcome. This exploratory study indicates that HR-pQCT with μFEA performed within four weeks after a distal radius fracture captures biomechanical fracture characteristics that are associated with long-term functional outcome and therefore could be a valuable early outcome measure in clinical trials and clinical practice. •HR-pQCT scans can be used to assess the healing process of distal radius fractures.•μFEA-derived stiffness is associated with functional outcome 2 years post-fracture.•Early torsional/bending stiffness may be most important for functional recovery.•Fracture region micro-architecture is not associated with long-term function.