Broken wrists (wrist fractures) in people over 50 are very common, especially in women. There are approximately 78,000 each year in the UK.
Many patients recover well from a wrist fracture. However, over half may continue to have some degree of chronic pain, and 1 in 5 will develop long-term functional impairment and associated disability. Wrist fractures may affect the person's ability to work, look after themselves, prepare meals and move about confidently. Some patients may become frail and lose their independence.
We want to be able to forecast who will not recover well after a wrist fracture, so that those people can be offered more support and rehabilitation. We plan to analyse data from a large national database of anonymised GP records. This will allow us to look at use of healthcare, such as GP visits and medication use, and health outcomes in a very large number of people (>100,000) over a period of up to 30 years. We will investigate whether people become frail after their wrist fracture, and need more healthcare. The results will help us work out what features or characteristics of patients help to identify those at increased risk of poor long-term outcomes. We will then be able to design a screening tool for clinicians to use with patients who have a wrist fracture to assess who will need extra rehabilitation. Separately to this study, we are carrying out other work with clinicians and patients to design the best rehabilitation package. In the future we can then test the screening tool and the rehabilitation package in a trial.
Each year approximately 78,000 people in the UK aged over 50 experience a fragility fracture of the wrist. Many of these fractures occur in individuals who are functionally independent, active, and with good health-related quality of life. Existing research has largely investigated consequences of wrist fractures in older populations and often with a focus on pain and hand disability, falls and future fractures. Yet, an estimated 20% of patients with wrist fracture are thought to develop functional decline, frailty, with consequent increased use of healthcare.
Understanding the extent and burden of these long-term consequences and the prognostic factors that identify those at high risk is essential to select subgroups likely to benefit from early, targeted interventions.
In order to provide high quality evidence on prognosis and inform the design of future intervention studies, we propose to conduct a study using anonymised medical record data from a large, national primary care database, to investigate the burden and long-term impact of wrist fractures to patients and the NHS. This study will assess: i) long-term consequences in individuals aged >/=50 years, who are often still working at the time of fracture; ii) trajectories towards frailty and increased healthcare use which are essential to inform the long-term primary care management of patients post fracture, and iii) predictors associated with unfavourable outcomes.
Subsequent work will use these findings to design and evaluate a brief screening tool to assess patients at the time of fracture, for use in a future randomised trial evaluating the clinical/cost-effectiveness of targeted interventions for those at risk of poor outcomes.
Decline in function using electronic frailty index (eFI)1; Healthcare utilization; Complications in primary or secondary care; Non-wrist fragility fracture; All-cause mortality
Danielle van der Windt - Chief Investigator - Keele University
Milica Bucknall - Corresponding Applicant - Keele University
Claire Burton - Collaborator - Keele University
John Edwards - Collaborator - Keele University
Opeyemi Babatunde - Collaborator - Keele University
Stephen Gwilym - Collaborator - Oxford University Hospitals
Victoria Jansen - Collaborator - NHS England
Zoe Paskins - Collaborator - Keele University
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;Patient Level Index of Multiple Deprivation