Comparison of Distal Radius Fracture Outcomes in Older Adults Stratified by Chronologic vs Physiologic Age Managed With Casting vs Surgery

Abstract

ImportanceCasting is recommended for adults older than 65 years with distal radius fractures (DRFs) because similar long-term outcomes are achieved regardless of treatment. However, physiologically younger adults could benefit from operative DRF management despite advanced chronologic age.ObjectiveTo examine how chronologic age compares with measures of physiologic age in DRF treatment recovery.Design, Setting, and ParticipantsThis retrospective secondary analysis of the Wrist and Radius Injury Surgical Trial (WRIST) was performed from May 1 to August 31, 2022. WRIST was a 24-center randomized clinical trial that enrolled participants older than 60 years with unstable DRFs from April 1, 2012, to December 31, 2016.InterventionsParticipants selected casting or surgery. Patients who selected surgery were randomly assigned to volar lock plating, percutaneous pinning, or external fixation. Participants were stratified by chronologic age, number of comorbidities, and activity status.Main Outcomes and MeasuresThe primary outcome was Michigan Hand Outcomes Questionnaire (MHQ) score assessed at 6 weeks, 3 months, 6 months, and 1 year. Partial correlation (PC) analysis adjusted for confounding.ResultsThe final cohort consisted of 293 participants (mean [SD] age, 71.1 [8.89] years; 255 [87%] female; 247 [85%] White), with 109 receiving casting and 184 receiving surgery. Increased chronologic age was associated with increased MHQ scores in the surgery group at all time points but decreased MHQ scores in the casting group at 12 months (mean [SD] score, −0.46 [0.21]; P = .03). High activity was associated with improved MHQ scores in the surgical cohort at 6 weeks (mean [SD] score, 12.21 [5.18]; PC = 0.27; P = .02) and 12 months (mean [SD] score, 13.25 [5.77]; PC = 0.17; P = .02). Comorbidities were associated with decreased MHQ scores at all time points in the casting group. Clinically significant differences in MHQ scores were associated with low physical activity, 4 or more comorbidities, or increased age by 15 years.Conclusions and RelevanceIn this retrospective secondary analysis of WRIST, chronologic age was not associated with functional demand. These findings suggest that physicians should counsel active older adults with few comorbidities on earlier return to daily activities after surgery compared with casting.Trial RegistrationClinicalTrials.gov Identifier: NCT01589692

Volar Locking Plate versus Closed Reduction and Immobilization for Distal Radius Fracture in the Elderly: Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…7,12 Furthermore, functional outcomes are influenced by factors beyond chronological age, such as functional demands, preinjury activity levels, and comorbidity status. 29,30 However, these factors were not the subject of the current study and warrant further investigation.…”

Association of Open Reduction and Internal Fixation With Volar Locking Plate for Distal Radius Fractures With Patient-Reported Outcomes in Older Adults

“…Moreover, future DRF studies should focus on identifying which older adults would most greatly benefit from ORIF treatment compared with casting. Stratifying older adults by activity status, level of frailty, or number of comorbidities could be one method to estimate functional demand and integrate physiologic health into treatment decisions . We advise clinicians to prioritize identifying patient preferences for treatment recovery to assist them in making an informed decision about their treatment plan.…”

“…Stratifying older adults by activity status, level of frailty, or number of comorbidities could be one method to estimate functional demand and integrate physiologic health into treatment decisions. 49 , 50 , 51 , 52 We advise clinicians to prioritize identifying patient preferences for treatment recovery to assist them in making an informed decision about their treatment plan. Moreover, the consolidation of data from these RCTs suggests that ORIF is the optimal surgical fixation strategy in older adults compared with other methods, such as external fixation and percutaneous pinning.…”

Wrist & Hand

“…However, in the face of these different opinions, do these trial changes practice? In this study from Vancouver (Canada), the authors used population-level administrative health data from British Columbia to perform a retrospective cohort analysis of 52,916 patients with a closed middle-third clavicle fracture from 1998 to 2018 1. The study aimed to compare the proportion of these injuries that were managed operatively before and then post-publication of the Canadian Orthopaedic Trauma Society (COTS) trial.…”