Who crashes their car following wrist fracture?

BACKGROUND

Wrist fractures are common injuries associated with high disability in the early recovery period. The impact of wrist fractures on safe return to drive is not understood.

PURPOSE

(1) To compare the proportion of adults who were drivers in car crashes before and after wrist fracture; (2) To examine potential factors (demographic and/or clinical) associated with increased odds of being a driver in a car crash following wrist fracture.

STUDY DESIGN

Retrospective cohort study.

METHODS

Three state-wide government datasets (MainRoads Western Australia [WA], Hospital Morbidity Data Collection and the Emergency Department Data Collection) were used to obtain and link demographic, clinical and car crash information relating to adults with a wrist fracture sustained between 2008 and 2017. McNemar's tests were used to compare the proportion of drivers in a car crash within the 2 years prior to and following the fracture date. Multivariable logistic regressions were used to identify if any variables were associated with increased odds of crashing in the post-fracture period.

RESULTS

Data relating to 37,107 adults revealed a 3.3% (95% CI 3.0%-3.6%, p < 0.05) decrease in the proportion of drivers in a car crash following wrist fracture, persisting for the entire 2 years post-fracture, when compared to the proportion who crashed before their fracture. Those with more severe wrist fracture injury patterns had 79%(95% CI 1.07-3.0, p = 0.03) higher odds of having a crash in the first 3 months following their injury, compared to those with isolated wrist fracture injuries.

CONCLUSIONS

These results inform and update return to drive recommendations. The reduced proportion of drivers involved in crashes following wrist fracture persisted for 2 years; longer than the expected physical recovery timeframe. It is important that hand therapists actively educate the sub-group of adults with more severe wrist fracture injury patterns of the increased likelihood of car crash for the 3 months following their fracture.

Driving performance following a wrist fracture: A pilot study using a driving simulator

Introduction

Driving performance, as assessed using a driving simulator, after distal radius fracture has not been previously studied. Our aims were to undertake a pilot study to assess feasibility via: (i) acceptability of driving simulation for this assessment purpose, (ii) recruitment and retention, (iii) sample size calculation. Preliminary evaluations of differences in driving performance between individuals recovering from distal radius fracture and controls were conducted to confirm if the methodology provided meaningful results to aid in justification for future studies.

Methods

Driving performance of 22 current drivers (aged 21–81 years), recruited by convenience sampling, was assessed using a driving simulator. The fracture group included those recovering from distal radius fracture managed with open reduction and internal fixation using a volar plate. The control group were uninjured individuals. Assessment was performed approximately five weeks post-surgery and follow-up assessment two weeks later. Acceptability outcome measures included pain and simulator sickness scores, feasibility measures included retention rates and measures of driving performance included time spent speeding, time spent out of the lane, standard deviation of lateral position and hazard reactions.

Results

The assessment was completed by 91% of participants; two participants dropped out secondary to simulator sickness. Retention rates were 83%. Preliminary results suggest those with distal radius fracture spent more time out of the lane and less time speeding.

Conclusion

This method was sensitive, acceptable and feasible according to the parameters of this pilot study. The results from this small sample suggest that between-group differences in driving performance are measurable using driving simulation five weeks following distal radius fracture.

[Evaluation of driving fitness in patients with musculoskeletal disorders : A systematic review]

OBJECTIVE

Driving a motor vehicle is one of the most important aspects of personal mobility in our society. However, there is a lack of evidence regarding driving fitness after orthopedic or trauma surgery-related diseases. Aim of this systematic review was to support the treating physician to determine the individual driving fitness in patients with musculosceletal disorders.

MATERIAL AND METHODS

A systematic analysis was performed using the PubMed database. Following a predefined algorithm, all relevant articles published from 2013 to 2018 were included.

RESULTS

The results were categorized according to the affected part of the body into I. lower extremity and II. upper extremity. Also, results were subcategorized into movement restrictions caused by external joint-braces, musculoskeletal diseases, and postoperative conditions.

CONCLUSION

This article supports the treating physician to individually determine the driving fitness in patients with musculoskeletal disorders. However, only a few standardized tests exist to individually determine the driving fitness in patients with musculoskeletal disorders. A particular shortcoming was observed for impairments of the upper extremity.