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Unequal recovery among ethnic groups is noted after distal radius fracture

Sociodemographic factors such as gender and BMI may mediate some differences in outcomes.

Issue: March 2009

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DENVER — Research shows differences among ethnic groups regarding subjective outcomes for function, pain and well-being after distal radius fracture treatment.

In a retrospective study, Kenneth A. Egol, MD, and colleagues examined 100 black, 143 Latino and 250 white patients who were treated for a displaced distal radius fracture at the New York University Hospital for Joint Diseases. Patients with stable fractures underwent nonoperative care, while those with unstable fractures had either operative fixation or nonoperative treatment based on surgeon and patient preference.

At 3, 6 and 12 months, the investigators collected DASH, SF-36 and Visual Analog Scale scores to assess function, mental well-being and pain, respectively. They used multiple linear regression to model the outcomes by ethnicity and controlled for age, gender, fracture type, education level, mechanism of injury and baseline scores.

Outcomes

They found blacks and Latinos had poorer function than whites at nearly all of the follow-up intervals, but blacks had better function than whites and Latinos at 1 year. In addition, the 1-year functional results for blacks showed a significant improvement compared to the group’s 6-month outcomes.

Blacks and Latinos also showed no improvement in pain scores. Blacks had worse pain than whites at all follow-up intervals, and Latinos reported substantially worse pain compared to whites.

Using a multiple linear regression analysis to examine the outcomes for blacks and Latinos compared to whites, the investigators discovered a link between the pain and functional outcomes for blacks and Latinos and body mass index (BMI), gender and education level.

Sociodemographic factors

“Disparities in some outcomes found in our study were attenuated in both African-Americans and Latinos after controlling for sociodemographic factors,” Egol said during his presentation at the 24th Annual Meeting of the Orthopaedic Trauma Association. “This is an indication that perhaps BMI, gender and education may mediate some of the differential outcomes that we saw in this study.”

For more information:

• Kenneth A. Egol, MD, is an associate professor and the vice chairman at New York University Hospital for Joint Diseases, Department of Orthopaedic Surgery. He can be reached at 301 E 17th St., New York, NY; 212-598-3889; e-mail: Kenneth.Egol@nyumc.org. He receives research support from Stryker, Synthes and Biomet and is a consultant for Exactech.

Reference:

• Walsh MG, Davidovitch RI, Egol KA. Ethnic disparities in functional and mental recovery following fracture healing. Paper #34. Presented at the 24th Annual Meeting of the Orthopaedic Trauma Association. Oct. 16-18, 2008. Denver.