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Study finds similar outcomes for nonoperative vs. surgical treatment for elderly distal-radius fracture patients

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SAN FRANCISCO — While elderly patients who are treated for distal radius fractures nonoperatively may attain less range of motion than those treated surgically, new research presented here indicates that their limited range of motion does not appear to decrease their functional recovery at 1 year follow-up.

Kenneth A. Egol, MD, and colleagues reviewed outcomes for 206 patients older than 65 years who sustained displaced distal radius fractures and who failed to achieve acceptable outcomes after initial treatment with closed reduction. These patients were then all offered surgery, and those who refused were treated nonoperatively until their fracture healed, according to the study.

Specifically, 107 patients received splinting or casting, and 99 patients underwent either external fixation or internal fixation with volar locking plates, Egol said in his presentation at the at the American Academy of Orthopaedic Surgeons 75th Annual Meeting.

Despite a significant difference in average patient age between groups, investigators found no significant differences between surgical and nonsurgical patients in terms of fracture classification, occupation, tobacco use, socioeconomic status or baseline DASH functional scores.

At 1 year, the nonoperative treatment group had significantly better mean scores for pain, but had significantly worse results for wrist extension, wrist flexion and radial deviation.

However, the investigators found no significant differences between the groups regarding complication rates and DASH scores for function at any of the studied time points.

"Our results suggest that limitations in range of motion seen with nonoperative care do not seem to limit functional recovery at 1 year," Egol said. "Further prospective studies are needed. However, there are clearly defined indications for surgical treatment of this patient set."

For more information:

• Egol KA, Walsh M, Paksima N. Distal radius fractures in the elderly: Operative vs. nonoperative treatment. Paper #399. Presented at American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.