Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly

Abstract

Background: The usage of volar locking plate fixation for distal radial fractures has increased in older patient populations, despite the fact that surgical treatment in the elderly population has not clearly been proven to be superior to nonoperative treatment. The purpose of the present study was to compare nonoperative treatment with volar locking plate fixation with regard to clinical outcome for elderly patients with dorsally displaced distal radial fractures. Methods: In this study, 140 patients were randomly allocated to nonoperative treatment with a plaster splint (n = 72) or volar locking plate fixation (n = 68). The outcome variables were the Patient-Rated Wrist Evaluation (PRWE) score, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire score, EuroQol-5 Dimensions (EQ-5D) score, range of motion, grip strength, radiographic outcomes, and complications. Evaluation was performed at 3 and 12 months by unblinded observers. Results: At 3 months, 122 patients were evaluated, and at 12 months, 119 patients were evaluated. At 3 months, the volar locking plate group, compared with the nonoperative treatment group, had a better median PRWE score (10.3 compared with 35.5 points; p = 0.002), DASH score (14.4 compared with 29.2 points; p = 0.016), and grip strength (71.0% of the uninjured hand compared with 53.9%; p < 0.001). Significant differences in favor of the volar locking plate group remained at 12 months; compared with the nonoperative treatment group, the volar locking plate group had a better median PRWE score (7.5 points compared with 17.5 points; p = 0.014), DASH score (8.3 points compared with 19.9 points; p = 0.028), and grip strength (96.8% compared with 80.0%; p = 0.001). Radiographic measurements favored volar locking plate fixation at 3 and 12 months. Complication rates were similar, with 11% major complications in the nonoperative group compared with 14% major complications in the volar locking plate group (p = 0.606) and 11% minor complications in the nonoperative group compared with 20% minor complications in the volar locking plate group (p = 0.197). Conclusions: The PRWE scores, DASH scores, and grip strength were better for the volar locking plate group compared with the nonoperative group at 3 and 12 months. The complication rates were similar. Our results imply that there is a benefit for the elderly patient with an unstable dorsally displaced distal radial fracture to be treated with a volar locking plate. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Nonoperative treatment versus volar locking plate fixation for elderly patients with distal radial fracture: a systematic review and meta-analysis

“…Of 290 potentially eligible articles, most were excluded due to duplicates and lack of relevance. Finally, 11 studies [4,6,7,9,[16][17][18][19][20][21][22], including five RCTs [6,7,9,20,21], five retrospective studies [4,[16][17][18]22], and one prospective study [19], satisfied the inclusion criteria after screening and assessment. The studies were published from 2009 to 2019, most within the past 5 years.…”

“…Seven studies compared DASH scores between VLP and nonoperation groups [ 6 , 7 , 16 – 18 , 20 , 22 ]. As shown in Fig.…”

Patient-related outcome, fracture displacement and bone mineral density following distal radius fracture in young and older men

“…The chief concern in managing most fractures is anatomical restoration which is assumed necessary for functional outcome. In older individuals with distal radius fracture a certain degree of remaining displacement has commonly been accepted since several studies have found radiographic appearance not to be associated with self-reported outcome [17,18,20], however consensus is lacking [35]. In part this is related to inappropriate methodology (including not using median DASH values for statistical analysis as recommended) and inconsistent definitions of poor outcome [17,20].…”

Objective Outcome Measures Continue to Improve from 6 to 12 Months after Conservatively Treated Distal Radius Fractures in the Elderly—A Prospective Evaluation of 50 Patients

“…Grip strength was measured using an electronic hand dynamometer (EH101 CAMRY, by Camry scale). Grip strength is given as the mean of three measurements on each side [ 15 , 16 ]. The MCID of grip strength is 6.5 kg [ 17 ].…”