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

Abstract

Background Distal radius fractures can adversely affect wrist function; for men with this fracture, the role played by fracture severity, age and osteoporosis on fracture outcome has not been sufficiently studied. Objective To describe patient-reported outcome and the association with bone integrity, fracture severity and future fracture risk among young and older men with distal radius fracture. Methods This prospective study includes 133 men with acute distal radius fracture, mean age 54 (range 21–88), who were followed for 12 months. They were categorized as younger (< 65) and older (65+). Main outcome was DASH (Disability of the Arm, Shoulder and Hand) at 12 months; DASH > 15 was defined as poor outcome. Fractures were classified and radiographic displacement identified at initial presentation and follow-up. BMD was measured and FRAX 10-year probability of fracture calculated. Results Disability was higher in older men (DASHmedian 10 vs 2; p = 0.002); a clinically meaningful difference (ΔDASH = 10, p = 0.017) remained after adjustment for displacement, fracture classification and treatment method. Almost 50% of older men vs 14% in younger had poor outcome, p < 0.001. Bone mineral density did not independently predict outcome. Older men with a displaced fracture at initial presentation had greater disability (DASHmedian, IQR 45, 14;73) and risk of fracture (FRAXmajor osteoporotic 14, 8;21). Conclusion Men over the age of 65 with a distal radius fracture are more likely to have post-fracture disability regardless of radiographic appearance. Fracture displacement, indicating impaired bone strength, is also more common and associated with an increased risk of fracture within 10-years. Secondary fracture prevention should therefore be considered in men presenting with distal radius fracture.

Clinical Results of Distal Radius Intraarticular Comminuted Fractures in the Elderly: A Retrospective Comparative Analysis of Different Fixation Methods

“…Men are more prone to be affected by high-energy trauma-related DRF. Despite this, the overall incidence of DRF is greater in women than in men [1][2][3][4][5]. However, the incidence of comminuted intraarticular fractures increases with advancing age [1][2].…”

“…In contrast, in younger individuals, it's a well-studied fact that inadequate reduction is strongly related to unsatisfied clinic results. It's very difficult to figure out whether clinic results in the elderly may be attributed to normal age-related decreased function or radiologic appearance and diminished skeletal integrity due to age [3][4]7].…”

“…In the elderly population, this effect still remains unclear. In long-term follow-up, studies reported that articular incongruity resulted in arthritis and mild to moderate functional limitation [3][4]. Surgical treatment options are external fixation, dorsal plate fixation, volar plating, bridge plating, and fragment-specific fixation.…”

“…Distal radial fractures are commonly diagnosed as upper extremity fractures in emergency department visits. In the US, approximately 44% of upper extremity fractures are distal radius fractures [1][2][3][4]. In younger patients, distal radius fractures are usually caused by high-energy trauma, and in the elderly, distal radius fractures are caused by low to moderate-energy trauma with a background of osteopenia or osteoporosis.…”

“…In younger patients, distal radius fractures are usually caused by high-energy trauma, and in the elderly, distal radius fractures are caused by low to moderate-energy trauma with a background of osteopenia or osteoporosis. High-energy trauma seems to be mostly related to comminuted or intraarticular fractures, whereas low to moderate-energy trauma results in metaphyseal fractures [3][4].…”