Distal Radius Fractures in the Elderly

Abstract

Background Distal radius fractures represent some of the most common injuries to the upper extremity, yet current evidence demonstrates great variability in the management of this injury. Elderly patients, in particular, stand to benefit from the early mobilization provided by operative fixation with a volar bearing plate. Methods We conducted a retrospective chart review on all patients 65 years or older who underwent unilateral open reduction internal fixation of distal radius fractures using a volar bearing plate at a single institution between January 2014 and January 2016. We excluded patients with bilateral injuries, multiple fractures, and major injuries to the same extremity. Results Fifty-five patients met criteria for this study. By AO classification, we repaired 17 type A, 24 type B, and 14 type C fractures. At final radiographic measurements, average radial height compared with ulna measured −0.31 mm, average radial inclination measured 20.45 degrees, and average volar tilt measured 7.11 degrees. On discharge, 36 patients had wrist range-of-motion data consistent with a functional wrist. Four patients had limitations in the flexion/extension plane, 8 with radial-ulnar deviation, and 7 had limitations in both planes. Conclusions Distal radius fractures in the elderly may successfully be treated with a volar bearing plate. Useful strategies include supraperiosteal dissection of the radius from the pronator quadratus, use of a longer plate for stronger proximal fixation in osteoporotic bone, and regional block. This methodology allows for a safe procedure facilitating the early return of hand and wrist function.

Perioperative Morbidities in Distal Radius Fractures Treated Using Locking Plates in the Super-Elderly Population: A Retrospective Study

“… 18 , 29 , 30 , 31 Moreover, distal radius fractures are often the result of a low-energy fall on an outstretched wrist. 3 , 32 Older independent patients in good cognitive health seem to be at higher risk of sustaining a distal radius fracture as they still have the reflex to put their arm forward when they fall. 33 , 34 Most of the patients in our study were living independently at home when their fracture occurred, although 29% had a known mental disorder.…”

“… 1 Fractures of the distal end of the radius are the second most common fracture after hip fractures among the elderly population, representing 17% of all fractures. 2 , 3 , 4 , 5 , 6 , 7 However, age is not the only determinant of recovery capacity and the risk of surgical complications; other factors may influence the postoperative outcome.…”

A Cost-Effectiveness Analysis of the Various Treatment Options for Distal Radius Fractures

“…All transition-state probabilities and ranges can be seen in Table 1 . 3 , 5 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , …”

Current Management and Volar Locking Plate Fixation with Bone Cement Augmentation for Elderly Distal Radius Fractures—An Updated Narrative Review

“…ORIF using a volar locking plate (VLP) has been proved to provide good functional outcomes and to be cost-effective for both intra-articular and extra-articular DRFs [16,17]. In the elderly, volar locking plate fixation (VLPF) also seems to be a safe and effective procedure that facilitates early recovery of hand and wrist functions [18], and it leads to a similar complication rate to that from younger patients [19]. Nonetheless, except for providing better functional and radiographic assessment outcomes, VLPF is unable to superiorly improve the Disabilities of the Arm, Shoulder, and Hand (DASH) score and complication rates compared to other conservative treatments [11,12,19,20].…”