Timing of Return to Driving After Volar Locking-Plate Fixation of Distal Radius Fractures Without Wrist Immobilization: A Prospective Driving Simulator Study.

Background: Studies examining return to driving after volar locking-plate fixation (VLP) for distal radius fractures (DRFs) have used heterogeneous postoperative immobilization protocols, resulting in widely varying recommendations for the timing of return to driving. The aim of this study was to determine the timing of return to driving in patients with DRFs treated with VLP managed without postoperative immobilization. Methods: Patients with DRFs treated with VLP and healthy controls who routinely drive were prospectively enrolled. Driving performance was evaluated at postoperative weeks 1, 2, 3, 4, 6, and 8 using a driving simulator (DS), administered as 2 tasks: the Steering Operation Test (pylon-passing) and the Hazard Anticipation Task (urban driving). The Steering Operation Test outcomes included reaction time, accuracy, left-right balance, and adaptability. The Hazard Anticipation Task outcomes included maximum steering angle, number of collisions, percentage of distance speeding, average excess speed, average turning speed at intersections, and number of turn-signal errors. Moreover, demographic and clinical factors potentially associated with driving performance were explored only among patients with DRFs using multivariable analysis. Results: Twenty-seven patients completed the DS assessment at all 6 point sessions, and 25 healthy controls completed a single session. Accuracy on the Steering Operation Test was significantly lower in patients than in controls at postoperative weeks 1 and 2, whereas no significant between-group differences were observed from week 3 onward. No significant differences were observed between the groups in any of the indicators for the Hazard Anticipation Task. Multivariable analysis showed a negative correlation of steering accuracy with female sex and older age and a positive correlation with forearm pronation. Conclusions: In patients with DRFs after VLP without wrist immobilization, driving performance did not differ significantly from that of healthy controls at postoperative week 3. These findings suggest that postoperative week 3 could serve as a reference point when considering return to driving. Gradual and careful guidance on returning to driving is recommended for women, older adults, and patients with insufficient recovery in forearm pronation. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.