Long-term functional outcome of distal radius fractures is associated with early post-fracture bone stiffness of the fracture region: An HR-pQCT exploratory study

F. L. Heyer*, J. J. A. de Jong, P. C. Willems, J. J. Arts, S. G. P. Bours, S. M. J. van Kuijk, M. Poeze, P. P. Geusens, B. van Rietbergen, J. P. van den Bergh

*Corresponding author for this work

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Identifying determinants of long-term functional outcome after a distal radius fracture is challenging. Previously, we reported on the association between early HR-pQCT measurements and clinical outcome 12 weeks after a conservatively treated distal radius fracture. We extended the follow-up and assessed functional outcome after two years in relation to early HR-pQCT derived bone parameters.

HR-pQCT scans of the fracture region were performed in 15 postmenopausal women with a distal radius fracture at 1-2 (baseline), 3-4 weeks and 26 months post-fracture. Additionally, the contralateral distal radius was scanned at baseline. Bone density, micro-architecture parameters and bone stiffness using micro-finite element analysis (FEA) were evaluated. During all visits, wrist pain and function were assessed using the patient-rated wrist evaluation questionnaire (PRWE), quantifying functional outcome with a score between 0 and 100.

Two-year PRWE was associated with torsional and bending stiffness 3-4 weeks post-fracture (R-2: 0.49, p = 0.006 and R-2: 0.54, p = 0.003, respectively). In contrast, early micro-architecture parameters of the fracture region or contralateral bone parameters did not show any association with long-term outcome.

This exploratory study indicates that HR-pQCT with mu FEA performed within four weeks after a distal radius fracture captures biomechanical fracture characteristics that are associated with long-term functional outcome and therefore could be a valuable early outcome measure in clinical trials and clinical practice.

Original languageEnglish
Pages (from-to)510-516
Number of pages7
Publication statusPublished - Oct 2019


  • Fracture healing
  • Functional outcome
  • HR-pQCT
  • Finite element analysis
  • PAIN

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