EDITOR’S CHOICE Intermediate-Term Outcome After Distal Radius Fracture in Patients With Poor Outcome at 1 Year: A Register Study With a 2- to 12-Year Follow-Up Marcus Landgren, MD, PhD, * Vendela Teurneau, MD, * Antonio Abramo, MD, PhD,† Mats Geijer, MD, PhD,‡ Magnus Tägil, MD, PhD* Purpose Most patients recover well from a distal radius fracture (DRF). However, approxi- mately one-fifth have severe disability after 1 year when evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. In the present study, we evaluated this subgroup of patients in our register with an inferior outcome. We hypothesized that the patient-reported outcome would improve with time. Methods Since 2001, patients 18 years and older with a DRF, at the Department of Ortho- pedics, Skåne University Hospital (Lund, Sweden) are prospectively registered in the Lund Wrist Fracture Register. We have previously defined a DASH score above 35 at the 1-year follow-up as the cutoff of major disability. Between 2003 and 2012, 17% of the patients (445 of 2,571) in the register exceeded this cutoff. Three hundred eighty-eight were women and 57 men and the mean age was 69 years (range, 18e95 years). One-fourth had been surgically treated. In December 2014, 2 to 12 years after the fracture, a follow-up DASH questionnaire was sent to the 346 of 445 patients still alive. Results Seventy-three patients (27%) had initially been treated surgically and 196 (73%) non- surgically for their DRF. Two hundred sixty-nine of 346 patients (78%) returned the follow-up DASH questionnaire at 2 to 12 years (mean, 5.5 years) after the fracture. The overall median DASH score improved from 50 at 1 year to 36 at the 2- to 12-year follow-up, (P < .05). Forty-seven percent had improved to a score below the cutoff 35, but 53% remained at a high suboptimal level. Conclusions The subjective outcome after a DRF improves over time for patients with an inferior result at 1 year, but more than half of the patients continue to have major disability. (J Hand Surg Am. 2019;44(1):39e45. Copyright Ó 2019 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Prognostic II. Key words Distal radius fracture, treatment, patient-reported outcome, DASH, residual disability. From the *Department of Orthopedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund; the †Department of Hand Surgery Malmö, Skåne University Hospital, Malmö; and the ‡Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Received for publication February 27, 2018; accepted in revised form October 16, 2018. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. Corresponding author: Marcus Landgren MD, PhD, Department of Orthopedics, Skåne University Hospital, SE-221 85 Lund, Sweden; e-mail: marcus.landgren@med.lu.se. 0363-5023/19/4401-0007$36.00/0 https://doi.org/10.1016/j.jhsa.2018.10.015 Ó 2019 ASSH r Published by Elsevier, Inc. All rights reserved. r 39