The Association Between Depression and Antidepressant Use and Outcomes After Operative Treatment of Distal Radius Fractures at 1 Year

Thomas J McQuillan; David N Bernstein; Nelson Merchan; Jonathan Franco; Charles J Nessralla; Carl M Harper; Tamara D Rozental

doi:10.1016/j.jhsa.2022.08.018

The Association Between Depression and Antidepressant Use and Outcomes After Operative Treatment of Distal Radius Fractures at 1 Year

J Hand Surg Am. 2022 Dec;47(12):1166-1171. doi: 10.1016/j.jhsa.2022.08.018. Epub 2022 Oct 29.

Authors

Thomas J McQuillan¹, David N Bernstein¹, Nelson Merchan², Jonathan Franco¹, Charles J Nessralla¹, Carl M Harper², Tamara D Rozental³

Affiliations

¹ Harvard Combined Orthopedics Residency Program, Boston, MA.
² Department of Orthopedic Surgery, Harvard Medical School, Beth Israel Deaconess, Boston, MA.
³ Department of Orthopedic Surgery, Harvard Medical School, Beth Israel Deaconess, Boston, MA. Electronic address: trozenta@bidmc.harvard.edu.

PMID: 36319499
DOI: 10.1016/j.jhsa.2022.08.018

Abstract

Purpose: Depression has been linked to inferior clinical outcomes among upper extremity patients. It often is challenging to distinguish the symptoms of depression, symptoms of injury, and the interaction between these 2 entities after a patient has been injured. We aimed to study the differences in clinical outcomes after surgical fixation of distal radius fractures between patients with and without a documented history and treatment for depression.

Methods: All subjects with an isolated, acute distal radius fracture undergoing operative fixation in a 10-year period at a level 1 academic trauma center were screened. Baseline demographic data were collected, and psychiatric history and antidepressant use were recorded and verified with a pharmacy database. Quick Disability of the Arm, Shoulder and Hand (QuickDASH), range of motion, and grip strength were assessed at 12 months after surgery. Multivariable linear regression analysis was used to assess the association of depression with QuickDASH scores at 1 year after surgery.

Results: A total of 211 patients were available for 1-year follow-up, 50 of whom were being treated actively for depression with medication at the time of injury and 161 were without a known diagnosis of, or treatment for, depression. Demographic and injury characteristics were similar between both groups. In a multivariable linear regression model controlling for age, sex, and a history of osteoporosis, active treatment for depression was associated with a slight mean increase in QuickDASH scores, 6.5 (1.3-11.8), 1 year after surgery.

Conclusions: This study demonstrates a small increase in QuickDASH scores between subjects with a confirmed diagnoses of depression compared with all others after surgical fixation of distal radius fracture at 1-year follow-up. We suggest that a history of depression may portend worse clinical outcomes, although other factors, such as underreporting of depression may influence results.

Type of study/level of evidence: Prognostic IV.

Keywords: Antidepressant; depression; fracture; hand; radius.

MeSH terms

Antidepressive Agents / therapeutic use
Bone Plates
Depression / drug therapy
Fracture Fixation, Internal / methods
Humans
Radius Fractures* / surgery
Range of Motion, Articular
Treatment Outcome

Substances

Antidepressive Agents