Distal radius fractures in the superelderly: an observational study of 8486 cases from the Swedish fracture register

Abstract

Background The distal radius fracture (DRF) is the most common fracture in adults. With an ageing population, the number of wrist fractures in the superelderly (≥ 80 years) is expected to rise. Optimal treatment for displaced DRFs remains controversial, especially in the superelderly group. In addition, basic knowledge of the outcome after a DRF in this heterogenic group is lacking. The aim of this study was to study injury characteristics, treatment and outcome of DRFs in superelderly patients using data from a large national register. Methods We used prospectively collected data from the Swedish Fracture Register. All distal radius fractures registered between April 2012 and December 2018 in patients ≥ 80 years of age were included. Data on epidemiology, fracture type, trauma mechanism and treatment are registered by the physician treating the patient. Patients are also sent a subjective outcome questionnaire including EQ-5D, EQ-VAS and Short Musculoskeletal Function Assessment questionnaire (SMFA-score) at the time of injury and after 12 months. The 12-month questionnaire was sent to those who had completed the questionnaire at the time of injury. A Mann–Whitney U-test was used to assess differences between treatment methods. Results Mean age for this population was 86 years (80–105 years), a majority of the patients were female (86.7%). The dominating injury mechanism was a simple fall (74.6%) in the patient’s residence. The majority of fractures were AO type A (70%) followed by AO type C (20.9%) and type B (8.6%). The incidence of open fractures was significantly higher in females (2.6%) compared to males (1.5%). A majority of the fractures were treated with a cast (87.5%) with volar locking plate as the second most common treatment method (6.6%). Patient-reported outcome measures (PROMs) EQ-5D, EQ-VAS and the Arm Hand Function Index of the SMFA-score deteriorated somewhat one year after injury compared to pre-injury. PROMs did not correlate to treatment with cast or a volar plate. Conclusions This nationwide register study provides detailed data on DRFs in the superelderly regarding epidemiology, treatment and self-reported outcome. A good self-reported outcome is possible, but many patients do not recover completely. PROMs did not correlate to type of treatment. The frequency of open fractures was significantly higher in females. The reason for this is unclear but different skin thickness in older males versus females may be one explanation.

Can elderly patients regain their preoperative functional level after distal radius fracture type A? Results from a fracture register study using PROM

“…This allowed us to enroll as many patients as possible overseeing the longest possible observation period. This is in line with previous published studies that also used retrospective designs ( 8 , 13 – 15 ).…”

“…While results from Swedish fracture registers suggest a more conservative treatment (7,8), German surgeons seem more willing to opt for surgery (3,9). Surgery allows an early start of wrist movement, while casting for 6 weeks is accompanied by muscle loss and often loss of autarky for the elderly.…”

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

“… 23 Previous publications also showed no link between reduction loss and poor functional outcomes. 11 , 23 , 24 , 25 A recent article by Sagerfors et al 26 found that, in general, patient-related outcomes in the elderly (aged >80 years) were poorer 1 year after sustaining a distal radius fracture compared with the prefracture state. However, no difference was found between conservative treatment and volar plating.…”

New Research on Distal Radius Fractures

“…[2][3][4][5] The fracture pattern, surgeon preference and experience, and the literature orientation in any point in time guide hand surgeons in the management of distal radius fractures. [11][12][13][14][15][16] The evidence for best practice needs to be regularly updated through scientific rigor and peer review, a process that has survived the test of time in the surgical world. For this reason, HAND has dedicated a supplemental issue to the research in distal radius fractures highlighting current trends, techniques, and outcomes for hand surgeon's interpretation and resolution in their quest to provide the best possible prevailing care for their patients.…”