Patient-Reported Outcomes After Distal Radius Fractures Differ Across Geographic and Cultural Populations: A Global Systematic Review and Meta-Analysis.

Abstract

To assess patient reported outcome (PRO) heterogeneity across different cultural and geographical regions via a systematic review and meta-analysis of PROs following volar plate fixation of distal radius fractures. Data Sources: PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for randomized controlled trials from 2010 to 2023 reporting Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH, Patient-Rated Wrist Evaluation (PRWE), or Visual Analogue Scale (VAS) PROs. Randomized controlled trials with treatment arms consisting of open reduction and internal fixation utilizing a volar locking plate for adult distal radius fracture (OTA/AO 23) and reported DASH, QuickDASH, PRWE, or VAS PROs were included. Studies not published in English or that provided insufficient extraction data were excluded. Studies were characterized by country of origin, continent of origin, and cultural region of origin. Extracted data included PRO outcomes, patient demographics, and follow-up ranges. Random-effects meta-analysis was performed with Restricted Maximum Likelihood method, and subgroup analyses were performed to determine differences in pooled PROs across geographical and cultural regions. 52 treatment arms met inclusion criteria for DASH analysis, 33 for PRWE, and 23 for VAS. Significant mean DASH score heterogeneity existed across all studies (p<0.01). Nine cultural regions were represented in the DASH analysis and demonstrated significantly different pooled mean PRO scores (p<0.01). Significant mean PRWE score heterogeneity existed across all studies (p<0.01). Seven cultural regions were represented in the PRWE analysis and demonstrated significantly different pooled mean PRO scores (p<0.01). Significant mean VAS score heterogeneity existed across all studies (p<0.01). Eight cultural regions were represented in the VAS analysis and demonstrated significantly different pooled mean PRO scores (p<0.01). Patient reported outcomes following distal radius volar plate fixation demonstrated meaningful variation across cultural and geographic contexts. Outcomes from one cultural region may not be globally generalizable. Therapeutic, Level I.