JOT - 2026-05-27 - Journal Article
Patient-Reported Outcomes After Distal Radius Fractures Differ Across Geographic and Cultural Populations: A Global Systematic Review and Meta-Analysis.
Bilodeau RE, Bhadouriya RS, Klinger CE, van der List JP, Oquendo YA, Haeberle HS, Victory L, Msa, Katzir A, Barth KA, Dvorzhinskiy A, Ricci WM
Topics
Key Takeaway
DASH, PRWE, and VAS scores after volar locking plate fixation of distal radius fractures show statistically significant heterogeneity across up to 9 cultural regions (p<0.01 for all three instruments), meaning outcomes from any single region cannot be globally generalized.
Summary Depth
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Summary
This systematic review and meta-analysis queried PubMed, EMBASE, and Cochrane for RCTs reporting DASH, QuickDASH, PRWE, or VAS after volar locking plate fixation of OTA/AO 23 distal radius fractures, then stratified results by country, continent, and cultural region. Random-effects meta-analysis with REML demonstrated significant between-study heterogeneity for all three PRO instruments (p<0.01), with 7–9 cultural regions each showing significantly different pooled mean scores. The finding directly challenges the assumption that PRO benchmarks derived from one cultural context apply universally.
Key Limitation
English-language-only inclusion excludes a substantial proportion of Asian and non-Western RCTs, which are the regions most likely to differ from Western norms and are therefore the populations where generalizability is most clinically relevant.
Original Abstract
OBJECTIVES
To assess patient reported outcome (PRO) heterogeneity across different cultural and geographical regions via a systematic review and meta-analysis of PROs following volar plate fixation of distal radius fractures.
METHODS
Data Sources: PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for randomized controlled trials from 2010 to 2023 reporting Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH, Patient-Rated Wrist Evaluation (PRWE), or Visual Analogue Scale (VAS) PROs.
STUDY SELECTION
Randomized controlled trials with treatment arms consisting of open reduction and internal fixation utilizing a volar locking plate for adult distal radius fracture (OTA/AO 23) and reported DASH, QuickDASH, PRWE, or VAS PROs were included. Studies not published in English or that provided insufficient extraction data were excluded.
DATA EXTRACTION
Studies were characterized by country of origin, continent of origin, and cultural region of origin. Extracted data included PRO outcomes, patient demographics, and follow-up ranges.
DATA SYNTHESIS
Random-effects meta-analysis was performed with Restricted Maximum Likelihood method, and subgroup analyses were performed to determine differences in pooled PROs across geographical and cultural regions.
RESULTS
52 treatment arms met inclusion criteria for DASH analysis, 33 for PRWE, and 23 for VAS. Significant mean DASH score heterogeneity existed across all studies (p<0.01). Nine cultural regions were represented in the DASH analysis and demonstrated significantly different pooled mean PRO scores (p<0.01). Significant mean PRWE score heterogeneity existed across all studies (p<0.01). Seven cultural regions were represented in the PRWE analysis and demonstrated significantly different pooled mean PRO scores (p<0.01). Significant mean VAS score heterogeneity existed across all studies (p<0.01). Eight cultural regions were represented in the VAS analysis and demonstrated significantly different pooled mean PRO scores (p<0.01).
CONCLUSIONS
Patient reported outcomes following distal radius volar plate fixation demonstrated meaningful variation across cultural and geographic contexts. Outcomes from one cultural region may not be globally generalizable.
LEVEL OF EVIDENCE
Therapeutic, Level I.