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Results reveal ethnic disparities in recovery after distal radial fractures
Walsh M. JBJS. 2010; 92:1082-1087.
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Recovery from distal radial fractures varies for different ethnic groups, according to New York researchers.
Michael Walsh, PhD, and colleagues at the NYU Hospital for Joint Diseases suggest that multifactorial sociodemographic issues present before and after fracture treatment may cause these discrepancies.
Walsh and his colleagues retrospectively reviewed 496 patients — 253 whites, 100 blacks and 143 Latinos — who had a distal radial fracture. The investigators assessed the patients’ physical function and pain at 3, 6 and 12 months after treatment. They used the Disabilities of the Arm, Shoulder and Hand (DASH) score to assess physical function and the visual analog scale to assess pain, according to the study abstract.
The investigators used multiple linear regression to model physical function and pain across ethnicity while controlling for age, sex, injury mechanism, education level, fracture type and treatment (operative vs. nonoperative) and Worker’s Compensation status.
Results showed that at most follow-up points, blacks and Latinos had poorer physical function and more pain than whites. Latino patients reported more pain at 3, 6 and 12 months in comparison with blacks and whites (P<.01). After controlling for Worker’s Compensation status, which is often strongly associated with pain and function, these significant differences remained.
I applaud the authors for taking a commonly believed notion, which I learned in medical school, that different cultures verbalize their pain in varying degrees, to the evidence-based criteria of proof. While realizing that there are cultural differences, it is important to note that patients deserve individualized care and assessment. This is especially true for distal radius fractures, where reports of ongoing pain require investigation for developing reflex sympathetic dystrophy, a common sequelae of distal radius fractures.
- John S. Taras, MD
Chief, Division of Hand Surgery
Drexel University
Philadelphia