Assessment of Anatomic Restoration of Distal Radius Fractures Among Older Adults

Abstract

IMPORTANCE The value of precise anatomic restoration for distal radius fractures (DRFs) in older adults has been debated for many decades, with conflicting results in the literature. In light of the growing population of adults aged 60 years and older, both fracture incidence and associated treatment costs are expected to increase. OBJECTIVE To determine the association between radiographic measures of reduction and patient outcomes after DRF in older patients. DESIGN, SETTING, AND PARTICIPANTS Data were collected from the Wrist and Radius Injury Surgical Trial (WRIST), a multicenter randomized clinical trial of DRF treatments for adults aged 60 years and older (enrollment from April 10, 2012, to December 31, 2016, with a 2-year follow-up). Data analysis was performed from January 3, 2019, to August 19, 2019. WRIST participants who completed 12-month assessments were included in the study. According to the biomechanical principle of alignment, 2-phase multivariable regression models were adopted to assess the association between radiographic measures of reduction and functional and patient-reported outcomes 12 months following treatment. INTERVENTIONS Participants were randomized to receive volar locking plate, percutaneous pinning, or external fixation. Those who opted for nonoperative treatment received casts. MAIN OUTCOMES AND MEASURES Hand grip strength, wrist arc of motion, radial deviation, ulnar deviation, the Michigan Hand Outcomes Questionnaire (MHQ) total score, MHQ function score, and MHQ activities of daily living score were measured at 12 months following treatment. RESULTS Data from 166 WRIST participants (144 [86.7%] women; mean [SD] age, 70.9 [8.9] years) found that only 2 of the 84 correlation coefficients calculated were statistically significant. For patients aged 70 years or older, every degree increase in radial inclination away from normal (22°) grip strength in the injured hand was 1.1 kg weaker than the uninjured hand (95% CI, 0.38-1.76; P = .004) and each millimeter increase toward normal (0 mm) in ulnar variance was associated with a 10.4-point improvement in MHQ ADL score (95% CI, −16.84 to −3.86; P = .003). However, neither of these radiographic parameters appeared to be associated with MHQ total or function scores. CONCLUSIONS AND RELEVANCE The study results suggest that precise restoration of wrist anatomy is not associated with better patient outcomes for older adults with DRF 12 months following treatment. Surgeons can consider this evidence to improve quality of care by prioritizing patient preferences and efficient use of resources over achieving exact realignment. (continued) Key Points Question What is the association between radiographic measures of reduction and patient outcomes 12 months after distal radius fractures treatment for adults aged 60 years or older? Findings This secondary analysis of a multicenter randomized clinical trial on distal radius fractures treatment options included 166 patients who completed 12-month assessments. Radiographic parameters were not assoc...

Evaluating the Impact of Social Deprivation on Mid-Term Outcomes Following Distal Radius Open Reduction Internal Fixation

“…39 – 43 However, multiple studies have also suggested that clinically important differences in the outcomes are not associated with anatomic radiographic reduction parameters and that other factors may play a more important role. 27 , 44 – 52 This study supports that near-anatomic reduction, especially at the time of long-term follow up, may provide no clinically important additional benefit. More studies are needed to evaluate whether a poor anatomic reduction leads to long-term issues due to potential changes in carpal stability and radiocarpal degenerative changes.…”

“… 2 , 3 Much of the research regarding the outcomes of distal radius fracture ORIF has focused on postoperative complications and the restoration of anatomic alignment. 1 , 4 – 6 …”

Do Patients Care What Their X-rays Look Like?

“…reported and objective functional outcome measures among 166 patients aged 60 years or older who completed 12-month assessments. 1 In keeping with other similar analyses of both older 2,3 and younger 4 patients, Chung et al 1 found little association of patients' radiographic measurements with their outcomes. This is important because the rationale for intervening surgically is essentially based on the premise that restoring the patient's preinjury anatomy will provide better outcomes when the fracture heals.…”

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“…Distal radius fractures (DRF) are one of the most common types of fractures in orthopedics [1,2] .With an ageing population, the incidence of distal radius fracture is increasing [3,4] .Currently, there are two main methods for treating distal radius fractures, surgical and nonsurgical [1,[5][6][7] . However, whichever the method is adopted, there will still be different degrees of wrist joint dysfunction, such as pain, swelling, joint range of motion and strength decline after fracture, affecting the daily life and work [8,9] .It is of great signi cance to explore a simple, effective and scienti c functional rehabilitation exercise.…”