Wrist fractures are common injuries and are associated with temporary high disability during the early stages of recovery.

However, little evidence is available to support recommendations for returning to drive after a wrist fracture and there are no guidelines, here or internationally, to assist clinicians.

Perth-based physiotherapist and accredited hand therapist Dr Susie Stinton says she gets asked all the time when patients can return to driving.

Her frustration with the lack of evidence led her to complete a PhD at the University of Sydney on the topic.

‘When you see people post-injury, many will ask when they can return to drive.

‘Anecdotally, I kept hearing that people were being told different things by colleagues or other professionals.

‘A person would come in saying, “Look, my doctor told me one thing and the surgeon said another. What do you think?”’ Susie says.

‘There’s a lot of inconsistent information out there and a lot of anecdotal information and not much quality evidence.

‘So that was why I started this research project.’

A pilot study published by Susie and her colleagues in Hand Therapy in 2019 (Stinton et al 2019) showed that the driving performance of people who had had surgery to treat a wrist fracture was significantly different from the control group at five weeks post-surgery but not at seven weeks.

While the results suggested that the injury could affect real-life driving performance during the recovery period, the researchers wanted to know if that equated to an increased risk of car accidents.

To try to answer this question, Susie turned to three very large government data registries in Western Australia—MainRoads Western Australia, the Hospital Morbidity Data Collection and the Emergency Department Data Collection—allowing her to look at clinical and car crash information about adults with a risk fracture sustained during a ten-year period, in a study recently published in the Journal of Hand Therapy (Stinton et al 2023).

‘Using these statewide datasets, we were able to identify a large cohort, essentially everyone who had had a wrist or forearm fracture managed in a Western Australian hospital over a 10-year period,’ Susie says.

With the assistance of Western Australia’s Data Linkage Services, part of the state’s Department of Health, Susie and her team linked demographic, health and car crash information from the datasets to look at whether the risk of car crash increased after wrist fracture in more than 37,100 drivers.

The study compared the number of car accidents experienced by the patients in the cohort in the two years prior to their injury to the number of car accidents they experienced in the two years post-fracture, with the data collected prior to the fracture acting as a control for the post-fracture data.

Surprisingly, there was a 3.3 per cent decrease in the proportion of drivers in a car crash following wrist fracture, which persisted over the entire two-year period post-fracture.

However, when the data was looked at more closely, particularly the first three months post-fracture, a different picture emerged.

In the subgroup of people who were in a car crash during the first three months after wrist fracture, those who had a more severe fracture were 79 per cent more likely to have a crash than people who had a minor fracture.

‘It was a big change in the odds and that association was only there during the first three months, not over the longer term,’ Susie says.

‘That follows what you’d expect given that most of the recovery happens within that three-month period, even if you have a severe injury.

‘After that, from an injury point of view, you would expect driving performance to return to a baseline level.’

Several other risk factors were identified by the study, including gender (male drivers were more likely to have a crash than female drivers), age (younger drivers were more likely to have a crash than older drivers) and employment (workers were more likely to have a crash than non-workers).

In fact, across the full two years post- injury, being employed increased the risk of a car crash.

‘My gut feeling was that it was partially related to driving exposure; if you’ve got a job and driving is your means of getting to that job, then you need to drive.

‘In addition, some jobs have driving as a requirement within normal work duties.

‘It may just have been the pressure to take less time off driving because of the need to work,’ Susie says.

While the limitations of the data used in the study mean that it’s hard to know exactly why the overall number of incidents went down across the two-year period, Susie says there are a few hypotheses.

One suggestion is that post-fracture, people might not be driving as much as normal, in part due to having to take time off work for recovery.

Another hypothesis suggests that driving confidence post- wrist fracture might be an issue.

Other factors that were not able to be examined in the study include hand dominance, whether the left or right wrist was broken and how long people waited before driving again.

While further studies are not currently planned, Susie says the next step might be to look at changes in driving behaviour post-injury.

‘In the driving assessment world, a lot of studies are using what they call naturalistic data now, where people are asked to have video cameras or GoPros in their car so that their driving can be mapped in real time,’ she says.

‘I think we can confidently say that we’ve proved that there is a relationship between wrist fracture, performance and crash risk.

‘I would love to see some more concrete data in terms of time frames and linking some of those clinical variables to either car crash risk or driving performance.

‘From a clinical point of view, that needs to be the next question in order to give us some clinical guidelines.’

In the meantime, Susie says, hand therapists and other clinicians working with patients who have had more severe wrist injuries should inform them of the increased risk of a car crash in the first three months following their fracture.

>> References available here.

>> An infographic outlining the study and its results is available here