A Systematic Review of Outcomes and Complications of Treating Unstable Distal Radius Fractures in the Elderly

Abstract

Purpose As the population in developed countries continues to age, the incidence of osteoporotic distal radius fractures (DRFs) will increase as well. Treatment of DRF in the elderly population is controversial. We systematically reviewed the existing literature for the management of DRFs in patients 60 and over with five common techniques: volar locking plate system (VLPS), non-bridging external fixation (non-BrEF), bridging external fixation (BrEF), percutaneous Kirschner-wire fixation (PKF), and cast immobilization (CI). Methods Articles retrieved from MEDLINE, Embase and CINAHL Plus that met predetermined inclusion and exclusion criteria were reviewed in two literature reviews. Outcomes of interest included wrist arc of motion, grip strength, functional outcome measurements, radiographic parameters, and the number and type of complications. The data were statistically analyzed using weighted means and proportions based on the sample size in each study. Results 2,039 papers were identified, and 21 papers fitting the inclusion criteria were selected in the primary review of articles with mean patient age of 60 and over. Statistically significant differences were detected for wrist arc of motion, grip strength, and DASH score, although these findings may not be clinically meaningful. Volar tilt and ulnar variance revealed significant differences amongst the groups, with CI resulting in the worst radiographic outcomes. The complications were significantly different, with CI having the lowest rate of complications, whereas VLPS had significantly more major complications requiring additional surgical intervention. Conclusions This systematic review suggests that despite worse radiographic outcomes associated with CI, functional outcomes were no different than surgically treated groups for patients 60 and over. Prospective comparative outcomes studies are necessary to evaluate the rate of functional recovery, cost, and outcomes associated with these 5 treatment methods. Level of Evidence Therapeutic, Level III

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

“…273 Care of the patient with a distal radius fracture is also costly: A cost of US$7788 (between years 2000 and 2005) has been estimated for a Medicare patient with a distal radius fracture. 274 Despite their frequency, treatment of distal radius fractures in elderly patients is controversial 275 …”

Functional, Clinical and Radiological Outcome of Extra Articular Distal End Radius Fracture in Elderly Patients, Closed Reduction and Cross K-wiring Versus Conservative Management (Closed Reduction and Casting)

“…Maintenance of satisfactory alignment is difficult. 6,7,8,9 Recent studies indicate high rate of re-displacement, reangulation and remanipulation following closed reduction and cast immobilization. 8,9 Supplementary percutaneous K-wire fixation resulted in a significantly better maintenance of the alignment of the completely displaced fractures of the distal radius.…”

Linking of the American Academy of Orthopaedic Surgeons Distal Radius Fracture Clinical Practice Guidelines to the International Classification of Functioning, Disability, and Health; International Classification of Diseases; and ICF Core Sets for Hand Conditions

“…This focus aligns well with the target audience being orthopedic surgeons. Health policymakers, funders, and clinicians should be aware that as the guidelines do not address function, 14 they are not appropriate for rehabilitation professionals or other groups who are focused on functional outcomes. CPG may be developed by multidisciplinary teams and should address comprehensive management or be very focused on a specific intervention or target user.…”

“…6 Study shows that more than 640 000 cases of DRF were reported during 2001 in North America, 14 and nearly 372 000 individuals of age 65 years and older sustain DRF every year in the United States. 35 Many studies describe the extent of impairments and disabilities experienced by the patients with DRF.…”