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Casting for elderly patients with distal radius fractures found a viable treatment
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The best treatment for intra-articular distal radius fractures in elderly patients is not definite, and it is unclear whether surgical management with volar locking plate fixation yields better functional outcomes or quality of life than cast immobilization. But, during the past decade, volar locking plates became the standard treatment for intra-articular distal radius fractures in elderly patients, Christoph Bartl, MD, said.
“Our recently presented randomized trial showed cast immobilization is an effective treatment option for the majority of elderly patients with these types of fractures,” he told Orthopaedics Today Europe.
“We found a trend for better results in the surgical group in health-related quality of life (HRQoL) scores and wrist function after 12 months, but without a significant advantage. Higher fracture severity grades correlated with a higher conversion rate to secondary surgical management and the early advantage in the range of motion after 3 months diminished after 12 months, and the conversion group achieved the same results like the primary surgical intervention group,” Bartl said in a presentation.
“Cast immobilization is still a relevant treatment option for managing intra-articular distal radius fractures in elderly patients,” Bartl said.
Bartl and colleagues conducted a randomized, controlled, multicenter trial of 185 elderly patients with intra-articular distal radius fractures who underwent either surgery or cast immobilization. Quality-of-life scores and functional outcomes, as well as range of motion at 1 year after randomization were the main outcome parameters and these were compared between groups.
Images: Bartl C
Ninety-four patients were assigned to surgical management with volar locking plate fixation and 91 patients were assigned to undergo closed reduction and cast immobilization for 6 weeks.
Overall, 40% of patients in the cast group had significant loss of reduction and subsequently underwent conversion to secondary surgical management. After 1 year, Bartl and colleagues found that surgery was not superior to cast immobilization since the groups’ scores, in terms of HRQoL and SF-36, were similar.
“After 3 months, as we suspected, we saw superior results in radiographic outcomes with better restoration of the joint anatomy in the surgical group and advantages in range of motion for the surgical group for almost all degrees of freedom. At 1 year, we found a trend for better results in the surgical group for the SF-36 physical component score and similar results for the DASH, the EQ-5D score and wrist range of motion,” Bartl said.
Volar locking plates achieved superior anatomic restoration of the distal radius for palmar tilt, ulnar variance and radial inclination (P < .05), but this did not translate into superior wrist function for elderly patients compared to cast immobilization 1 year after the injury. – by Robert Linnehan
- References:
- Bartl C, et al. Dtsch Arztebl Int. 2014. doi:10.3238/arztebl.2014.0779.
- Bartl C, et al. Paper #59. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 16-18, 2014; Tampa, Fla., USA.
- For more information:
- Christoph Bartl, MD, can be reached at Department of Orthopaedic Trauma Surgery, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; email: chbartl@gmx.de.
Disclosure: Bartl reports no relevant financial disclosures.