Surgeon: Many osteoporotic patients do well with conservative treatment of distal radius fractures

SAN FRANCISCO — Among patients who have osteoporosis, surgically managing distal radius fractures can sometimes have unsatisfactory outcomes due to the poor reliability of the fixation that can be obtained, according to a surgeon speaking here. For these patients, conservative management approaches may result in good functional outcomes, he noted.

"This can be a very elderly, sometimes perhaps senile or cognitively impaired individual, who is also low-demand ... and doesn't require a perfect anatomical reduction," said Terry S. Axelrod, MD, MSc, FRCS(C), of Toronto. "Unfortunately, that message is being missed."

Axelrod's comments came during his presentation at the American Academy of Orthopaedic Surgeons 75th Annual Meeting.

In his abstract for the presentation, Axelrod noted that these patients can be divided into three categories: those who usually receive conservative treatment, those who may receive conservative treatment, and those who rarely receive such treatment.

Patients who should always receive conservative management include nursing home residents who are cognitively impaired, bedridden or have low functional demands. Patient who may receive conservative care include elderly, relatively independent patients who are functional, who have a mildly displaced fracture that can be predicted to heal with an acceptable deformity, or who may have medical or psycho-social comorbidities.

Patients who will rarely receive conservative care are those who live independently, have higher functional demands or have a severe fracture displacement or comminution.

Axelrod said that it is important to remember that conservative management does not mean no management. "Many fractures can be reduced under regional block, conscious sedation or hematoma block into a reasonable alignment. That reduction can then be maintained with a proper protocol of splinting, follow up, repeat manipulation and casting as necessary," he said.

Many times treatment is patient-specific and often the physician will have to talk to the patient, look at his or her background and speak with the family to determine the proper treatment course, he noted.

For more information:
Axelrod TS. Nonoperative (conservative) treatment: When I use it. Presented at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.