Epidemiology of distal radius fractures: Elucidating mechanisms, comorbidities, and fracture classification using the national trauma data bank

•High-energy trauma mechanisms are associated with displaced and open distal radius fractures.•Risk factors for poor skin quality are associated with open distal radius fractures.•In the inpatient operative repair of distal radius fractures, mechanism of injury and frailty are associated with longer length of stay.•Frailty is a risk factor for adverse discharge disposition following inpatient surgical fixation of distal radius fractures. An update on the epidemiology of distal radius fractures in the United States is necessary, particularly as the elderly population grows. Additionally, age and frailty have been associated with complications following surgical fixation of DRFs. Herein, we utilize the National Trauma Data Bank, a robust nationwide resource, to investigate the relationship between demographics, comorbidities, injury and fracture characteristics, and admission details. Patients with isolated distal radius fractures were identified from the National Trauma Data Bank (2016–2019) according to ICD-10 codes. Univariate and multivariate regressions were conducted to determine independent risk factors for bilateral fractures, displaced fractures, open fractures, as well as length of hospital stay and adverse discharge disposition for patients undergoing inpatient surgical fixation. The incidence of DRFs was 3.6/1,000 trauma-related emergency department visits and 10.8/1,000 upper extremity traumas. Trauma mechanism was significantly associated with displaced and open fractures. Age (OR 1.01, 95% CI 1.01–1.01), BMI (OR 1.02, 95% CI 1.01–1.02), smoking (OR 1.34, 95% CI 1.15–1.57), and alcohol level (trace: OR 2.18, 95% CI 1.41–3.29; intoxicated: OR 2.20, 95% CI 1.63–2.95) were significantly associated with open fractures. Machinery (β=2.04, 95% CI 1.00–3.08) and MVT (β=0.39, 95% CI 0.08–0.69) mechanisms were independent risk factors for longer length of stay. mFI-5 was an independent risk factor, in a stepwise fashion, for both length of stay and adverse discharge disposition. High-energy mechanisms and risk factors for poor skin quality were significantly associated with open fractures. mFI-5 was an independent risk factor for longer length of stay and non-routine discharges in patients of all ages, despite controlling for other comorbidities, unrelated complications, and mechanism of injury. Trauma mechanism was an independent risk factor for prolonged length of stay only, particularly in patients younger than 65 years of age.