Upper-limb physical activity after distal radius fractures treated operatively or nonoperatively: a secondary analysis of a multicenter randomized trial

BACKGROUND AND PURPOSE: While most patients recover well from distal radius fracture, some experience prolonged deficits. We aimed to primarily compare high-intensity upper-limb activity 12 months after operative vs nonoperative treatment of malaligned distal radius fractures and secondarily to assess the impact of fracture alignment and compare activity levels with healthy older adults. This is a secondary analysis of the Distal Radius Fracture Trial. METHODS: The Distal Radius Fracture Trial was a multicenter, randomized controlled trial. Patients with malaligned distal radius fractures were randomized to operative treatment with a volar locking plate or nonoperative treatment. Patients with well-aligned distal radius fractures constituted a separate non-randomized group. High-intensity upper-limb activity was measured using wrist-worn accelerometers at 3 and 12 months. Healthy subjects were recruited for comparison. Longitudinal analyses were performed using linear mixed models. RESULTS: 157 patients and 59 healthy controls provided valid accelerometer data. At 12 months patients with malaligned fractures treated operatively had significantly higher high-intensity activity in the affected upper limb than those treated nonoperatively (37 vs 28 min/day; adjusted difference 8.5 min/day, 95% confidence interval [CI] 0.3-17). Fracture alignment was not significantly associated with activity. Compared with healthy subjects, operatively treated patients showed no clear difference (2.7 min/day, CI -8.3 to 14), whereas nonoperatively treated patients demonstrated lower activity levels (12 min/day, CI 4.4-20). CONCLUSION: In patients with malaligned distal radius fractures, operative treatment was associated with higher high-intensity upper-limb activity at 12 months than nonoperative treatment. The activity level in operatively treated patients was similar to that observed in healthy older adults.