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Anatomic reduction not always necessary in treating elderly patients’ distal radius fractures
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CHICAGO — Achieving an anatomic reduction for distal radius fractures in elderly patients may not always be necessary for good functional outcomes, according to investigators.
“Plate and screw fixation [for distal radius fractures] was developed to improved anatomic alignment, minimize anatomic congruities and dysfunction for the benefit of younger patients,” Charles S. Day, MD, said. “However, there is conflicting data on the relationship between wrist function and radiographic alignment in an older cohort.”
Day and colleagues from Beth Israel Deaconess Medical Center in Boston conducted a retrospective call-back study of patients with distal radius fractures who were older than 55 years, with a mean follow-up of 6 months since the initial treatment.
He presented data from the study at the 63rd Annual Meeting of the American Society for Surgery of the Hand, held here.
Treatment was based on the clinical judgment of the surgeon at the time of fracture. Conservative treatment was considered closed reduction with immobilization. Twenty-six patients received conservative treatment, Day said.
The surgical cohort included 27 patients who underwent closed reduction with percutaneous pinning, open reduction and internal fixation (ORIF), or ORIF with external fixation.
“We took extensive, detailed outcome measurements, including five radiographic measurements: range of motion with strength, flexion/extension, radial/ulnar deviations, supination/pronation and grip/pinch strength,” he said.
The investigators also included four subjective functional assessments as well as a new survey called the Modern Activity Subjective Survey of 2007 (MASS07). According to Day, the unique aspect about this survey is that it looks at modern activities such as keyboarding and using a computer mouse, cell phones and handheld devices.
“In terms of the radiographic results, we saw that there was a significant difference in the dorsal tilt and the brachial shortening in the operative and nonoperative groups,” he said. “There was a trend that the nonoperative group had more displacement.”
In terms of range of motion, there was no difference between the two groups. The groups’ subjective scores in the DASH, MASS07 and Patient-Related Wrist Evaluation also showed no difference.
Using a multivariate analysis that assessed possible variables, the researchers found no difference across gender, age and time to follow-up, he added.
“Surgical treatment of distal radius fractures reduces incidence of displacement,” Day said. “Surgical treatment, however, does not improve function based on this analysis.”
The investigators concluded that anatomic reduction appears to have no effect on the range of motion or objective or subjective functional assessments in patients 55 years old or older.
For more information:
- Day CS, Synn AJ, Makhni EC, et al. Distal radius fractures in elderly patients: Is anatomic reduction necessary? Paper 44. Presented at the 63rd Annual Meeting of the American Society for Surgery of the Hand. Sept. 18-20, 2008. Chicago.