Patient-Reported Outcomes After Distal Radius Fractures Differ Across Geographic and Cultural Populations: A Global Systematic Review and Meta-Analysis

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.