Effectiveness of surgical versus conservative treatment of distal radius fractures in elderly patients: A systematic review and meta-analysis

Gutiérrez-Espinoza, Héctor; Araya-Quintanilla, Felipe; Olguín-Huerta, Cristian; Gutiérrez-Monclus, Rodrigo; Valenzuela-Fuenzalida, Juan José; Román-Veas, Javier; Campos, Christian T.

doi:10.1016/j.otsr.2022.103323

Cited by 24 publications

(14 citation statements)

References 60 publications

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“…Regarding patient-reported outcome measures, most of the studies included in this NMA compared volar locking plate versus cast immobilization [ 29 , 32 , 34 , 35 , 38 , 46 , 48 , 51 , 53 ]. Consistent with our findings, previous meta-analyses reported no statistically significant or clinically relevant differences in functional outcomes between surgical and nonoperative treatments in patients older than 60 years with DRF [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Despite the worse radiographic outcomes associated with closed reduction and cast immobilization, these findings suggest that redisplacement does not affect functional outcomes in these patients [ 8 , 19 ].…”

Section: Discussionsupporting

confidence: 92%

“…Despite the high incidence of displaced or unstable intra-articular and/or extra-articular DRFs and the potential implications of suboptimal management, high-level scientific evidence on the best method of treatment in patients older than 60 years is not available [ 10 , 19 ]. Accordingly, the findings of two NMAs of RCTs performed in all patients with DRF showed controversial results [ 3 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the high incidence of displaced or unstable DRFs, no consensus has been reached on the optimal treatment method in patients older than 60 years [ 10 ]. Several systematic reviews with or without meta-analyses have been published on the comparison between surgical and nonoperative treatment in this age group [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. These meta-analyses found no statistically significant or clinically relevant differences (the observed differences did not exceed published estimates of the minimally clinically important difference) in functional outcomes between surgical and nonoperative treatment in these patients [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…Several systematic reviews with or without meta-analyses have been published on the comparison between surgical and nonoperative treatment in this age group [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. These meta-analyses found no statistically significant or clinically relevant differences (the observed differences did not exceed published estimates of the minimally clinically important difference) in functional outcomes between surgical and nonoperative treatment in these patients [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Regarding the safety of different treatment modalities in patients with DRF, a recent network meta-analysis (NMA) showed no difference in the risk of complications between nonoperative treatment and any surgical intervention in patients older than 60 years [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness and Safety of Different Treatment Modalities for Patients Older Than 60 Years with Distal Radius Fracture: A Network Meta-Analysis of Clinical Trials

Gutiérrez-Espinoza

Araya-Quintanilla

Cuyúl-Vásquez

et al. 2023

IJERPH

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The aim of this study was to compare the clinical effectiveness and complications of different treatment modalities for elderly patients with distal radius fracture (DRF). Methods: We performed a network meta-analysis (NMA) of randomized clinical trials (RCTs). Eight databases were searched. The eligibility criteria for selecting studies were RCTs that compared different treatment modalities (surgical or nonoperative) in patients older than 60 years with displaced or unstable intra-articular and/or extra-articular DRFs. Results: Twenty-three RCTs met the eligibility criteria (2020 patients). For indirect comparisons, the main findings of the NMA were in volar locking plate (VLP) versus cast immobilization, with the mean differences for the patient-rated wrist evaluation (PRWE) questionnaire at −4.45 points (p < 0.05) and grip strength at 6.11% (p < 0.05). Additionally, VLP showed a lower risk ratio (RR) of minor complications than dorsal plate fixation (RR: 0.02) and bridging external fixation (RR: 0.25). Conversely, VLP and dorsal plate fixation showed higher rates of major complications. Conclusions: Compared with other treatment modalities, VLP showed statistically significant differences for some functional outcomes; however, most differences were not clinically relevant. For complications, although most differences were not statistically significant, VLP was the treatment modality that reported the lowest rate of minor and overall complications but also showed one of the highest rates of major complications in these patients. PROSPERO Registration: CRD42022315562.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effectiveness and Safety of Different Treatment Modalities for Patients Older Than 60 Years with Distal Radius Fracture: A Network Meta-Analysis of Clinical Trials

Gutiérrez-Espinoza

Araya-Quintanilla

Cuyúl-Vásquez

et al. 2023

IJERPH

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“…Despite the worse radiographic outcomes associated with CRPC, many studies have shown that differences in functional outcomes compared with those treated surgically are not clinically significant (37). Evidence of a relationship between radiological reduction criteria and functional outcomes in elderly people is still equivocal (38).…”

Section: Discussionmentioning

confidence: 99%

Comparison between closed reduction plaster casting and percutaneous Kirschner wire pinning in the management of distal radius fractures in patients aged 65 years and older

Karadeniz

Yurtbay

Ozturk

et al. 2022

Journal of Health Sciences and Medicine

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Aim: Closed reduction plaster casting (CRPC) and percutaneous pinning (CRPP) remain an important treatment modalities for extra-articular distal radius fractures especially in elderly patients. These two treatment methods have advantages and disadvantages compared to each other. The ideal treatment of extra-articular distal radius fractures is still debatable. We aimed to retrospectively evaluate the clinical and radiological results after CRPC and CRPP for the treatment of distal radius fractures in the patient population over 65 years of age. Material and Method: Between 1 January 2015 and 1 January 2019, patients older than 65 years of age who presented with extra-articular noncomminuted distal radius fractures were retrospectively evaluated. 95 patients diagnosed with distal radius fracture were separated into 2 groups, who were administered the following: CRPC (n:51), CRPP (n:44). We compared the characteristics of the patients, the mechanisms of injury, fracture types and treatment methods, pre-reduction and post-reduction radiological parameters and clinical functions for the two groups. Volar tilt, radial inclination, ulnar variance, and radial length were compared. Clinical results were also compared. Results: The mean follow-up period was 19.8 months (range, 12-29 months; SD=11.0) in the CRPC group and 18.6 months (range, 12-26 months; SD=10.9) in the CRPP group. Mean range of motion and grip strength were maintained in both treatment groups at one-year follow-up. There was no statistically significant difference between the groups (p>0.05). There was no statistically significant difference between the groups in terms of the scores evaluating the daily activity, pain and mental status of the patients after the treatment (p>0.05). There are no statistically significant differences between fixation with CRPC and CRPP in terms of clinical and radiological results (p>0.05). Conclusion: Closed reduction plaster casting and closed reduction percutaneous pinning are equally effective in the treatment of extra-articular distal radius fractures in the elderly.

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Baseline predictors related to functional outcomes in patients older than sixty years with complex regional pain syndrome type 1 after distal radius fracture treated conservatively: a prospective observational study

Román-Veas

Gutiérrez-Monclus

López-Gil

et al. 2023

International Orthopaedics (SICOT)

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Effectiveness of surgical versus conservative treatment of distal radius fractures in elderly patients: A systematic review and meta-analysis

Cited by 24 publications

References 60 publications

Effectiveness and Safety of Different Treatment Modalities for Patients Older Than 60 Years with Distal Radius Fracture: A Network Meta-Analysis of Clinical Trials

Effectiveness and Safety of Different Treatment Modalities for Patients Older Than 60 Years with Distal Radius Fracture: A Network Meta-Analysis of Clinical Trials

Comparison between closed reduction plaster casting and percutaneous Kirschner wire pinning in the management of distal radius fractures in patients aged 65 years and older

Baseline predictors related to functional outcomes in patients older than sixty years with complex regional pain syndrome type 1 after distal radius fracture treated conservatively: a prospective observational study

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