Nonoperative treatment compared with volar locking plate fixation for displaced and unstable distal radius fractures in patients sixty-five years of age and older – A prospective randomized trial

Abstract

Recent trends have shown a decrease in nonoperative management for unstable distal radial fractures in elderly. The literatures available lack adequate information whether operative treatments are superior to nonoperative (cast) treatment. The purpose of this study was to compare the outcomes of two treatment methods that were used: (1) ORIF with volar locking plate and (2) closed reduction and plaster immobilization. 70 patients with a displaced and unstable distal radial fracture were randomized to ORIF with volar locking plate (n=35) or closed reduction and cast immobilization (n=35). Outcome was measured on the basis of the Patient-Rated Wrist Evaluation (PRWE) score; the Disabilities of the Arm, Shoulder and Hand (DASH) score; the pain level; the range of wrist motion; the rate of complications; and radiographic measurements including dorsal radial tilt, radial inclination, and ulnar variance. Patients in the operative treatment group had lower DASH and PRWE scores, indicating better wrist function in early postoperative period (p<0.05), but there were no significant differences between the groups at six and twelve months. Grip strength, dorsal radial tilt, radial inclination, and radial shortening were significantly better in the operative treatment group at the time of the latest follow-up (p<0.05).

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

“…Nonetheless, the functional recovery and complication rate were not compromised in this group. Additionally, in this group there is a growing body of evidence in support of non-operative treatment in the long-term and a suggestion to reserve surgery for patients in need of fast recovery [ 15 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”