The Necessity of Restoration of Radiologic Parameters by Closed Reduction in Elderly Patients with Distal Radius Fractures

Abstract

BackgroundThe aim of this study was to evaluate the influence of distal radius fractures (DRFs) malalignment on the treatment outcomes in patients over age 65 years.Material/MethodsWe retrospectively reviewed the records on fresh DRFs treated with closed reduction from December 2014 to January 2018. After treatment, patients were evaluated for the determination of grip strength, the Visual Analog Scale (VAS) during wrist movement, the Patient-Rated Wrist Evaluation (PRWE), the Disabilities of the Arm, Shoulder and Hand (DASH) score, the appearance satisfaction, and active wrist range of motion (ROM).ResultsA total of 96 patients with complete data were included in our study. During follow-up, there were 75 patients (78.1%) with acceptable reduction and 21 patients (21.9%) with unacceptable reduction. Compared with those having acceptable alignment in the distal radius, patients with unacceptable alignment had weak grip strength, were unsatisfied appearance, and had severe flexion as well as ulnar deviation limitation at 6-month follow-up. A significant correlation was found between ulnar positive variance and grip strength (r=−0.35, P=0.03), as well as dorsal angulation and flexion movement (r=−0.31, P=0.02).ConclusionsConservative treatment should be used differently, even in elderly patients. For low-demand patients, it is not necessary to restore all anatomic radiographic parameters, as malalignment does not increase disability or pain score. However, for patients who are still healthy and active, satisfactory reduction is the first choice, as malalignment can lead to decreased grip strength, dissatisfaction with appearance, and certain wrist limitations.

Outcomes and complications of operative versus non-operative management of distal radius fractures in adults under 65 years of age

“…Despite the increased incidence of complications with operative treatment of DRF, operative treatment was associated with a reduction in fracture malunion. An inverse age-dependent tolerability for residual anatomic deformity has been proposed, and is supported by the increased incidence of secondary procedures in the non-operatively managed cohort (Kong et al., 2019; Perugia et al., 2014; Synn et al., 2009).…”

“…Less robust evidence exists to guide the management of DRFs in patients between 18 and 64 years of age, compared with that for the elderly patient population, with a general consensus that instability and residual deformity are better tolerated with advancing age (Azad et al., 2019; Kong et al., 2019; Perugia et al., 2014; Synn et al., 2009). The primary aim of this study was to assess the patient-specific demographic factors and co-morbidities associated with both operative and non-operative management of DRFs for the patients under 65 years of age.…”

Radiocarpal joint stiffness following surgical treatment for distal radius fractures: the incidence and associated factors

“…Dorsal angulation, radial inclination, and radial shortening were three parameters used to assess the distal radius deformity [24]. Surgeons usually strive for an anatomic reduction, yet obtaining the anticipated reduction may be very hard or even impossible in some cases.…”

Clinical Utility of 3-Dimensional Reconstruction Images to Predict Conservative Treatment Outcomes of Intra-Articular Distal Radius Fractures

“…They can be caused by a simple fall in elderly individuals who have weak bone or by high-energy trauma in young adults [ 1 ]. The management for DRFs is variable, and both conservative and surgical treatment methods have been used for patients [ 2 , 3 ]. Regardless of the method, the main goal is to restore the articular surface and the anatomical alignment of the distal radius.…”