Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register

Abstract

Background: Distal radius fractures are the most common of all fractures. Optimal treatment is still debated. Previous studies report substantial changes in treatment trends in recent decades. Few nation-wide studies on distal radius fracture epidemiology and treatment exist, none of which provide detailed data on patient and injury characteristics, fracture pattern and mortality. The aim of this study was to describe the epidemiology, fracture classification, current treatment regimens and mortality of distal radius fractures in adults within the context of a large national register study.

Methods: We performed a descriptive study using prospectively registered data from the Swedish fracture register. Included were all non-pathological distal radius fractures registered between January 1st 2015 and December 31st 2017 in patients aged 18 years and above. Nominal variables were presented as proportions of all registered fractures.

Results: A total of 23,394 distal radius fractures in 22,962 patients were identified. The mean age was 62.7 ± 17.6 years for all, 65.4 ± 16.0 for women and 53.6 ± 20.0 for men. A simple fall was the most common cause of injury (75%, n = 17,643/23,394). One third (33%, n = 7783/21,723) of all fractures occurred at the patients' residence. 65% (n = 15,178/23,394) of all fractures were classified as extra-articular AO-23-A, 12% (n = 2770/23,394) as partially intra-articular AO-23-B and 23% (n = 5446/23,394) as intra-articular AO-23-C. The primary treatment was non-surgical for 74% (n = 17,358/23,369) and surgical for 26% (n = 6011/23,369) of all fractures. Only 18% of the AO-23-A fractures were treated surgically, compared to 48% of the AO-23-C fractures. The most frequently used surgical method was plate fixation (82%, n = 4954/5972), followed by pin/wire fixation (8.2%, n = 490/5972), external fixation (4.8%, n = 289/5972) and other methods (4.0%, n = 239/5972). The overall 30-day mortality was 0.4% (n = 98/23,394) and the 1-year mortality 2.9% (n = 679/23,394).

Conclusion: This nation-wide observational study provides comprehensive data on the epidemiology, fracture classification and current treatment regimens of distal radius fractures in a western European setting. The most common patient was an eldery woman who sustained a distal radius fracture through a simple fall in her own residence, and whose fracture was extra-articluar and treated non-surgically.

Keywords: Distal radius fracture; Epidemiology; Fracture classification; Register study; Surgical treatment; Swedish fracture register.

Fig. 1

Distribution of distal radius fractures per age interval and sex

Fig. 2

a Proportion of distal radius fractures (%) per injury cause. b. Proportion of distal radius fractures (%) for each injury cause in women and men respectively. c. Proportion of distal radius fractures (%) for each injury cause by age category (18–65 years or ≥66 years)

Fig. 3

Distribution of distal radius fractures per month of the year

Fig. 4

Distribution of distal radius fractures per day of the week by age category (18–65 years or ≥66 years)

Fig. 5

Schematic illustration of the AO/OTA classification system for distal radius fractures, as seen in the SFR

Fig. 6

Distribution of distal radius fractures for each primary treatment type as well as surgical method by AO/OTA fracture type