Comparing the Outcomes of Surgical and Non-Surgical Approaches in Management of Older Patients with Distal Radius Fracture; a Retrospective Cohort Study
Archives of Academic Emergency Medicine,
Vol. 10 No. 1 (2022),
1 January 2022
,
Page e62
https://doi.org/10.22037/aaem.v10i1.1606
Abstract
Introduction: Distal radius fractures (DRFs) are the most common orthopedic injuries in emergency department. This study aimed to compare the outcomes of conservative and surgical managements of DRFs in the aged population.
Methods: In this retrospective cohort study, ninety patients with unilateral DRFs were treated using either surgical or conservative (casting) approach and the management outcomes as well as complications were compared between the two groups at 3 and 6-month follow-ups.
Results: A total of 90 patients over 70 years old were included (45 treated with cast immobilization, and 45 using the surgical method). The mean age (p = 0.56) and gender (p = 0.85) was similar in the two groups. Except for quality of life in both follow-up times, patients treated with surgical methods showed better outcomes in other aspects, including 3-month (p = 0.042) and 6-month (p = 0.022) mean Disability of the Arm Shoulder Hand (DASH) score, 3-month (p = 0.013) and 6-month (p = 0.006) mean range of motion (ROM), and 3-month (p = 0.003) and 6-month (p = 0.033) pain intensity based on Visual Analogue Scale (VAS). A total of 70 (77.77%) adverse events were registered (33 (36.6%) in the casting group and 37 (41.1%) in the surgical group; p = 0.05). The rate of mal-union (p = 0.021) and superficial radial nerve injury (p = 0.026) were significantly lower in the surgical group.
Conclusion: The findings suggest that surgical approach for management of DRFs in elder cases has better clinical and functional outcomes than cast immobilization.
- Conservative treatment
- radius fractures
- casts, surgical
- aged
- disabled persons
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References
Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113-25.
Jerrhag D, Englund M, Karlsson MK, Rosengren BE. Epidemiology and time trends of distal forearm fractures in adults - a study of 11.2 million person-years in Sweden. BMC Musculoskelet Disord. 2017;18(1):240.
Earnshaw SA, Cawte SA, Worley A, Hosking DJ. Colles' fracture of the wrist as an indicator of underlying osteoporosis in postmenopausal women: a prospective study of bone mineral density and bone turnover rate. Osteoporos Int. 1998;8(1):53-60.
Cuddihy MT, Gabriel SE, Crowson CS, O'Fallon WM, Melton LJ, 3rd. Forearm fractures as predictors of subsequent osteoporotic fractures. Osteoporos Int. 1999;9(6):469-75.
Nordvall H, Glanberg-Persson G, Lysholm J. Are distal radius fractures due to fragility or to falls? A consecutive case-control study of bone mineral density, tendency to fall, risk factors for osteoporosis, and health-related quality of life. Acta Orthop. 2007;78(2):271-7.
Jariwala AC, Phillips AR, Storey PA, Nuttall D, Watts AC. Internal fixation versus other surgical methods for treating distal radius fractures in adults. Cochrane Database Syst Rev. 2018;2018(7):CD011212.
Hammert WC, Kramer RC, Graham B, Keith MW. AAOS appropriate use criteria: treatment of distal radius fractures. J Am Acad Orthop Surg. 2013;21(8):506-9.
Bartl C, Stengel D, Bruckner T, Gebhard F. The treatment of displaced intra-articular distal radius fractures in elderly patients. Dtsch Arztebl Int. 2014;111(46):779-87.
Wong TC, Chiu Y, Tsang WL, Leung WY, Yam SK, Yeung SH. Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population: a prospective randomised controlled trial. J Hand Surg Eur Vol. 2010;35(3):202-8.
Handoll HH, Madhok R. Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003(2):Cd000314.
Mulders MAM, van Eerten PV, Goslings JC, Schep NWL. Non-operative treatment of displaced distal radius fractures leads to acceptable functional outcomes, however at the expense of 40% subsequent surgeries. Orthop Traumatol Surg Res. 2017;103(6):905-9.
Rhee PC, Shin AY. Management of Complex Distal Radius Fractures: Review of Treatment Principles and Select Surgical Techniques. J Hand Surg Asian Pac Vol. 2016;21(2):140-54.
Toon DH, Premchand RAX, Sim J, Vaikunthan R. Outcomes and financial implications of intra-articular distal radius fractures: a comparative study of open reduction internal fixation (ORIF) with volar locking plates versus nonoperative management. J Orthop Traumatol. 2017;18(3):229-34.
Levin LS, Rozell JC, Pulos N. Distal Radius Fractures in the Elderly. J Am Acad Orthop Surg. 2017;25(3):179-87.
Handoll HH, Madhok R. Closed reduction methods for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003;2003(1):Cd003763.
Martineau PA, Berry GK, Harvey EJ. Plating for distal radius fractures. Orthop Clin North Am. 2007;38(2):193-201, vi.
Egol KA, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N. Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Joint Surg Am. 2010;92(9):1851-7.
Jupiter JB, Marent-Huber M. Operative Management of Distal Radial Fractures with 2.4-Millimeter Locking Plates: A Multicenter Prospective Case Series: Surgical Technique. JBJS. 2010;92(Supplement_1_Part_1):96-106.
Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am. 2011;93(23):2146-53.
Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am. 2004;29(1):96-102.
Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Qual Life Res. 2005;14(3):875-82.
Mousavi SJ, Parnianpour M, Abedi M, Askary-Ashtiani A, Karimi A, Khorsandi A, et al. Cultural adaptation and validation of the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Clin Rehabil. 2008;22(8):749-57.
Vogt MT, Cauley JA, Tomaino MM, Stone K, Williams JR, Herndon JH. Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk factors. The study of osteoporotic fractures. J Am Geriatr Soc. 2002;50(1):97-103.
Ostergaard PJ, Hall MJ, Rozental TD. Considerations in the Treatment of Osteoporotic Distal Radius Fractures in Elderly Patients. Curr Rev Musculoskelet Med. 2019;12(1):50-6.
Testa G, Vescio A, Di Masi P, Bruno G, Sessa G, Pavone V. Comparison between Surgical and Conservative Treatment for Distal Radius Fractures in Patients over 65 Years. J Funct Morphol Kinesiol. 2019;4(2):26.
Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma. 2009;23(4):237-42.
Ju JH, Jin GZ, Li GX, Hu HY, Hou RX. Comparison of treatment outcomes between nonsurgical and surgical treatment of distal radius fracture in elderly: a systematic review and meta-analysis. Langenbecks Arch Surg. 2015;400(7):767-79.
Chan YH, Foo TL, Yeo CJ, Chew WY. Comparison between cast immobilization versus volar locking plate fixation of distal radius fractures in active elderly patients, the Asian perspective. Hand Surg. 2014;19(1):19-23.
Hung LP, Leung YF, Ip WY, Lee YL. Is locking plate fixation a better option than casting for distal radius fracture in elderly people? Hong Kong Med J. 2015;21(5):407-10.
Bruce KK, Merenstein DJ, Narvaez MV, Neufeld SK, Paulus MJ, Tan TP, et al. Lack of Agreement on Distal Radius Fracture Treatment. J Am Board Fam Med. 2016;29(2):218-25.
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