Elsevier

Injury

Volume 35, Issue 5, May 2004, Pages 462-466
Injury

The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK

https://doi.org/10.1016/S0020-1383(03)00117-7Get rights and content

Abstract

Adults who suffer fractures of the distal radius are at increased risk of further osteoporosis related fractures and represent a high-risk group in whom therapies are available to reduce the risk. We have undertaken a prospective study of distal radius fracture patients over the age of 25 years to establish the extent of the problem in Dorset. All patients presenting with any forearm fracture to hospitals serving Dorset residents during 1 year were identified. Fracture type was assessed following scrutiny of the hospital notes. Analysis included calculation of rates per 10,000 population using Dorset Health Authority population estimates and seasonal variation. Ninety-six percent of all patients presented to three of the seven hospitals. One thousand six hundred and eighty-eight individuals with a diagnosis of forearm fracture were identified but only 1300 had a fracture of the distal radius. There was a female:male ratio of 3.9:1. In women, the incidence of distal radius fracture rose from a premenopausal baseline of 10 per 10,000 population per year to a peak of 120 per 10,000 population per year over 85 years. In men, the fracture incidence gradually increased from 10 per 10,000 before 65 years to 33 per 10,000 after 85 years. There was a detectable seasonal variation. Our data are in keeping with recent surveys in Europe and suggest that a change in the incidence of fracture of the distal radius with age has occurred over the last 30 years.

Introduction

A fracture of the distal radius usually follows a fall onto the outstretched arm and is related to osteoporosis in postmenopausal women.11 These fractures are painful, frequently require closed and sometime open reduction and are associated with complications such as reflex sympathetic dystrophy.2 In one study, 20% of cases were hospitalised and up to half of cases lost some function permanently.4

In women, the incidence of distal radius fracture is reported to rise after the menopause reaching a plateau between 60 and 70 years.10 In men, with a four-fold lower incidence,10 there is a steady increase between 20 and 80 years. Previous studies have suggested that these fractures occur more frequently during the winter months with more occurring outdoors than hip fractures.11

A history of a fracture of the distal radius over the age of 25 years increases the risk of fractures at other sites by a factor of a least two.6., 15.

We are interested in fracture prevention in Dorset, a semi-rural county of approximately 700,000 people in the south of England. We have carried out a County wide, year long, prospective survey of distal radius fractures in patients over 25 years of age to determine the extent of the local problem and compare our statistics with published data.

Section snippets

Methods

Following Local Research Ethics Committee approval all accident and emergency departments in all hospitals in Dorset and surrounding areas were asked if they treated Dorset residents with forearm fractures. All such hospitals were included in the study. All patients over the age of 25 years attending the departments with a record of any forearm fracture during 1 year were identified from the hospital records within 4 weeks of their attendance. In Poole and Bournemouth Hospitals computerised

Results

Seven district and community hospitals with accident and emergency departments accepting forearm fracture patients permanently or temporarily resident in Dorset were identified.

One thousand six hundred and eighty-eight patients presented to those hospitals with a recorded diagnosis of forearm fracture during the 12 months study period (March 1996–February 1997). One hundred and thirty-three patients (11%) were not registered with a Dorset General Practitioner. Of these, nine patients were from

Discussion

Our study suggests that there is a continuous rise in the incidence of distal radius fractures with age in women over the age of 50 years and men over the age of 65 years in contrast to established findings of a plateau in incidence with age.

There have been two recent independent surveys in the UK that have also shown a steady rise in the incidence of distal radius fractures in women from a baseline of 10 per 10,000 per year at the age of 60 years to a peak of 120 per 10,000 per year at the age

Acknowledgements

We thank the consultants and staff of participating hospitals. Professor Peter Thomas of the Dorset Research and Development Support Unit gave statistical advice. The study was supported by a Research Grant from Dorset Health Authority and was supervised by the Scientific Committee of Osteoporosis Dorset (registered charity no. 1023507).

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