The impact of wrist and forearm fractures on return to driving

Abstract

The overall aim is to better understand return to driving following wrist fracture. The results from the review in Chapter Two concur that previous literature on driving following any upper limb injury is exceedingly limited. Up-to-date wrist fracture epidemiology in Australia is lacking. The aim of Chapter Three was to report on state-wide epidemiology and shows increasing incidence and changing management. As outcomes are worse when complications occur, Chapter Three also highlights the profile of individuals who are most likely to suffer complications. Wrist fractures result in functional limitation, especially in the acute recovery period. Given the difficulty in undertaking other daily activities, it is hypothesized driving performance is also impaired. To understand how return to driving fits in the recovery pathway, it is important to first understand the longitudinal recovery. Chapter Four reports on expected outcomes from the fracture date until the final result and shows initial high disability with rapid improvement over the first three months, followed by continued improvement for one year. As there are no standardised procedures to determine driving performance or car crash risk following upper limb injury, Chapter Five describes methodology using a driving simulator that proves to be a feasible method of measuring driving performance. In addition, Chapter Five provides preliminary suggestion of impairment in driving performance between those recovering from wrist fracture, when compared to healthy controls. Even if the driving performance is impaired following wrist fracture, it is not clear if this equates to an increased risk of car crash. Chapter Six shows there is no increase in rates of car crashes following wrist fracture, but more importantly profiles individuals most likely to crash following wrist fracture. The final conclusions from this thesis will assist in decision making regarding return to driving following wrist fracture.