Distal Radius Fractures in Older Patients: Is Anatomic Reduction Necessary?

Abstract

The relationship between radiographic and functional outcomes in older patients with distal radius fractures is controversial. We explored this relationship by assessing the influence of radiographic displacement and fracture comminution on the functional outcomes of these fractures. We also asked whether operative intervention and demographic factors (age, gender, duration of followup) influenced outcome. We examined 53 patients older than 55 years with distal radius fractures with various functional assessments: range of motion (ROM) and strength measurements, three subjective surveys (Disabilities of the Arm, Shoulder, and Hand; Patient-rated Wrist Evaluation; Modernized Activity Subjective Survey of 2007), a Gartland and Werley score, and an objective, standardized hand performance test (Jebsen-Taylor). We measured angulation, articular gap/stepoff, and radial shortening on final radiographs and fracture comminution of preoperative radiographs. We observed no effect of radiographic displacement on subjective or objective outcome assessments, including standardized hand performance timed testing. Surgically treated fractures were less likely to display residual dorsal angulation and radial shortening, but surgical intervention did not independently predict functional outcome. Fracture comminution, patient gender, and months of followup similarly had no effect on outcome. We found no relationship between anatomic reduction as evidenced by radiographic outcomes and subjective or objective functional outcomes in this older patient cohort.

Early postoperative improvements in the QuickDASH score after distal radius fracture are related to the type of surgical treatment

“…But there is currently no evidence that this anatomical reconstruction is beneficial for the patient's function and pain. Synn et al [19] cited nine studies that showed no beneficial effect on function despite improved radiological results and 11 studies that had better functional outcomes compared with other treatment methods, but all these studies involved elderly patients. Kumar et al [20] found that the QD after 14 months was related to the radiological results in patients under 60 years of age, but not in patients over 60 years of age.…”

The correlation of radiographic outcome to functional outcome following fracture of the distal radius in elderly patients: A literature review

“…38 However one study 37 did follow-up their participants for 5-6 years, and another 39 for an average of 39 months and although Brogren et al 39 found that there was correlation between malunion and poorer function and pain at 1 year, no such correlation was found in either study at long-term followup. These results, and those of others, 2 could suggest that radiological outcomes in the short-term (3-12 months) may have some effect on function, but in the long-term these effects lose significance.…”

“…Reviewing the literature, of the studies looking at elderly populations only, the majority 4,8,34,37,38,41 found no significant correlation between functional outcome and radiological outcome. Studies including patients of all ages were more likely to show some correlation between radiological outcome and function, with authors 2,35,36,40 citing radial shortening and dorsal/volar angulation as having the most significant effect on function.…”

Betydningen av feilstilling etter dorsalt vinklet distal radiusfraktur

“…I åtte studier (29,34,(48)(49)(50)(51)(52)(53)(54) med til sammen 498 pasienter var det ingen sammenheng mellom det røntgenologiske og det kliniske resultatet blant eldre, mens man i én studie (55) …”