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    When Can Patients Safely Drive after Surgery for Distal Radius Fractures?

    A recently published study sought to answer this question, with researchers putting patients through a series of tests on a closed driving course.

    Author

    Anthony Sapienza, MD

    Article

    Jones CM, Ramsey RW, Ilyas A, et al. Safe return to driving after volar plating of distal radius fractures. J Hand Surg Am. 2017 Sep;42(9):700-704.e2. doi: 10.1016/j.jhsa.2017.05.030.

    Summary

    A major concern for patients following distal radius fracture fixation is when they can resume driving. This decision has medical, legal, and safety considerations, but there are no evidence-based guidelines to assist the surgeon.

    Prior publications have examined functional ability to drive on a simulated course using different types of casts, but no studies had prospectively collected observed driving data on patients after postoperative fixation of distal radius fractures. This is the subject of the study by Jones et al, who sought to determine when these patients are capable of safely resuming driving.

    Patients enrolled in the study underwent a driving examination 2 weeks after surgery for volar plating of a distal radius fracture, with follow-up evaluations at 4 and 6 weeks if the patient failed the preceding examination. 

    The postoperative regimen was standardized, with patients receiving a thermoplastic wrist orthosis and starting supervised occupational therapy between 1 and 2 weeks after surgery. Patients were given the option of using or not using their orthosis for the driving examination.

    The driving examination took place on a closed course and evaluated the patients’ ability to:

    • Perform basic functions of vehicle operation, such as opening the door, starting the vehicle, shifting, and using turn signals)
    • Negotiate multiple isolated right and left turns and a low-speed serpentine curve segment
    • Perform a K-turn
    • Park the vehicle

    Patients were also given a subjective evaluation, including visual analog scale scores.

    A certified driver rehabilitation specialist (CDRS) performed all the driving examinations. The CDRS was a licensed occupational therapist who was certified through the Association of Driver Rehabilitation Specialists and certified as a Pennsylvania driving instructor.

    Patients failed if they were unable to adequately control the car with both hands in accordance with Pennsylvania Department of Transportation Driving Regulations or otherwise unable to complete the course.

    Twenty-three patients were enrolled, with 16 (69.5%) passing their first attempt (average of 18.4 days from surgery). Four patients (17.4%) passed their second attempt (31.3 days from surgery), and 3 did not complete the second examination.

    Patients who failed relied too much on their non-surgical hand, were not able to control the steering wheel with 2 hands, and reported pain and insecurity when using the operative hand. Of those who passed the second attempt, the first failure was universally attributed to pain.

    Fifteen patients reported a return to independent driving prior to the first examination (average, 11.3 days). Of the 7 who failed, 6 reported they could control the car in an emergency, and 2 reported they would not feel safe with daily driving.

    Maximum pain while driving on the visual analog scale was 2.4 of 10 among those who failed compared with 1.3 among those who passed.

    Patients in this study began driving on their own at an average of 13 days from surgery and 70% successfully passed the examination at an average of 18.4 days from surgery. 

    No correlation to likelihood of passing was found with:

    • Age
    • Laterality
    • Orthosis use
    • Strength
    • Range of motion
    • Patient-reported factors, such as pain and confidence

    Clinical Relevance

    The results of this study show that safe return to driving may be warranted within 3 weeks of distal radius volar plate fixation in some patients. Persistent pain was the primary limiting factor affecting driving ability and is likely the most important obstacle to a safe return to driving.

    However, the ability to safely operate a vehicle cannot be determined in the office. A case in Massachusetts found a physician responsible for a fatal motor vehicle accident involving his patient who had been cleared to drive while still consuming prescription opioids for a musculoskeletal injury. [1]

    Ultimately, the onus is on the patient to act sensibly, but surgeons should remain cautious about “clearing” a patient to drive.

    Reference

    1. Coombes v Florio, 877 N.E.2d 567 (Mass. 2007)

    Author Information

    Anthony Sapienza, MD, is an Assistant Professor of Orthopaedic Surgery, Division of Hand Surgery, Department of Orthopaedic Surgery, NYU Langone Medical Center, and Co-Director of the Hand Fellowship Program.