BACKGROUND Distal radius fractures have a psychological impact on patients, with the pain and disability caused by these injuries potentially leading to psychological distress. It is not known whether dominant-side and nondominant-side distal radius fractures cause more psychological distress in patients. QUESTIONS/PURPOSES (1) Compared with patients who have distal radius fractures on the nondominant side, do patients with dominant-side fractures experience greater pain? (2) Do patients with dominant-side distal radius fractures have greater disability? (3) Do patients with dominant-side distal radius fractures have worse psychological adjustment? (4) What factors are associated with a worse quality of life mental component measure? METHODS This retrospective study was conducted by the departments of orthopaedics-traumatology and psychiatry in a multidisciplinary manner at our university hospital, which is a public hospital. The study included 172 patients with distal radius fractures who were treated nonoperatively. We excluded 2% (3 of 172) of patients who underwent surgery because of loss of reduction, 1% (2 of 172) of patients with bilateral distal radius fractures, and 9% (16 of 172) of patients who did not consent to participate in the study. After the exclusion of 12% (21 of 172) of ineligible patients, the study continued with 88% (151 of 172) of patients. Forty-six percent (70 of 151) of patients had dominant distal radius fractures and 54% (81 of 151) of patients had nondominant distal radius fractures. The evaluation was carried out face-to-face at the end of the sixth week of treatment in the orthopaedic outpatient clinic. The VAS score was used to assess pain (this score ranges from 0 to 10, where 0 represents no pain and 10 represents the worst pain, with a minimum clinically important difference [MCID] of 2), the QuickDASH was used to assess disability (ranges from 0 to 100, representing best to worst, with an MCID of 15.9), the Brief Adjustment Scale-6 (BASE-6) was used to assess psychological adjustment (ranges from 6 to 42, lower scores indicate better outcomes), and the SF-12 was used to assess quality of life (ranges from 0 to 100, representing worst to best, with an MCID of 5). RESULTS At cast removal, patients with dominant-side distal radius fractures had higher levels of pain (dominant VAS median [IQR] 4 [4], nondominant VAS median 2 [3], median difference 2; p = 0.005), but the difference was not clinically important. There were no differences in disability (dominant QuickDASH median 63.6 [21], nondominant Quick DASH median 59.1 [25], median difference 4.5; p = 0.20). Psychological adjustment was worse in patients with dominant-side fractures (dominant BASE-6 median 22.5 [24.3], nondominant BASE-6 median 15 [23.5], median difference 7.5; p = 0.004). After accounting for variables such as age, occupation, and gender, a better quality of life mental component (SF-12 MCS) was associated with a lower BASE-6 (β = -0.67; p < 0.001) and nondominant fracture (β = -0.16; p = 0.006). CONCLUSION Dominant-side distal radius fractures have a negative impact on the psychological adjustment and quality of life of patients. Patients with dominant distal radius fractures are more susceptible to the development of psychological disorders. Future studies should assess whether providing appropriate counsel at the time of fracture may alleviate the psychological disorders experienced by patients with dominant-side distal radius fractures. LEVEL OF EVIDENCE Level III, therapeutic study.

中文翻译：

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优势侧桡骨远端骨折患者是否比非优势侧骨折患者有更大的心理困扰？


背景 桡骨远端骨折对患者有心理影响，这些损伤引起的疼痛和残疾可能会导致心理困扰。目前尚不清楚主导侧和非主导侧桡骨远端骨折是否会给患者带来更多的心理困扰。问题/目的 (1) 与非优势侧桡骨远端骨折的患者相比，优势侧骨折的患者是否会经历更大的疼痛？ （2）优势侧桡骨远端骨折患者的残疾程度是否更大？ （3）优势侧桡骨远端骨折患者的心理适应能力是否较差？ (4) 哪些因素与较差的生活质量心理成分测量相关？方法这项回顾性研究是由我校医院（公立医院）骨科、创伤科和精神科以多学科方式进行的。该研究纳入了 172 名接受非手术治疗的桡骨远端骨折患者。我们排除了 2%（172 人中的 3 人）因复位失败而接受手术的患者、1%（172 人中的 2 人）双侧桡骨远端骨折的患者以及 9%（172 人中的 16 人）不同意接受手术的患者。参与研究。在排除 12%（172 名中的 21 名）不符合条件的患者后，该研究继续对 88%（172 名中的 151 名）患者进行。 46%（151 人中的 70 人）的患者患有显性桡骨远端骨折，54%（151 人中的 81 人）患者患有非显性桡骨远端骨折。评估是在治疗第六周结束时在骨科门诊进行的。 VAS 评分用于评估疼痛（该评分范围从 0 到 10，其中 0 代表无疼痛，10 代表最严重的疼痛，最小临床重要差异 [MCID] 为 2），QuickDASH 用于评估残疾（范围从0到100，代表最好到最差，MCID为15.9），使用简短调整量表-6（BASE-6）来评估心理调整（范围从6到42，分数越低表明结果越好），以及SF-12用于评估生活质量（范围从0到100，代表最差到最好，MCID为5）。结果 拆除石膏时，优势侧桡骨远端骨折患者的疼痛程度较高（优势 VAS 中位数 [IQR] 4 [4]，非优势 VAS 中位数 2 [3]，中位差 2；p = 0.005），但差异临床上并不重要。残疾方面没有差异（显性 QuickDASH 中位数为 63.6 [21]，非显性 QuickDASH 中位数为 59.1 [25]，中位数差异为 4.5；p = 0.20）。优势侧骨折患者的心理调整较差（优势 BASE-6 中位数 22.5 [24.3]，非优势 BASE-6 中位数 15 [23.5]，中位差 7.5；p = 0.004）。在考虑了年龄、职业和性别等变量后，更好的生活质量心理成分 (SF-12 MCS) 与较低的 BASE-6 (β = -0.67; p < 0.001) 和非优势性骨折 (β = -0.16；p = 0.006）。结论 优势侧桡骨远端骨折对患者的心理适应和生活质量产生负面影响。桡骨远端显性骨折的患者更容易出现心理障碍。 未来的研究应该评估在骨折时提供适当的咨询是否可以减轻优势侧桡骨远端骨折患者所经历的心理障碍。证据级别 III 级，治疗研究。