Operative management of distal radial fractures reduced malunion
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Although nonoperative treatment of distal radial fractures in patients 65 years of age and older yielded a significant decrease in 1-year upper extremity-specific complications, published results showed operative treatment was associated with a reduction in malunion. Researchers recommend careful consideration of operative management when discussing distal radial fracture treatment options with elderly patients.
Using the OptumLabs Data Warehouse database, Sanjeev Kakar, MD, FAOA, and colleagues analyzed 90-day and 1-year complication rates per 1,000 fractures overall and by treatment modality among 13,713 patients 65 years of age and older who had been managed for distal radial fractures.
Results showed an overall 90-day complication rate of 36.5 per 1,000 fractures, as well as a 1-year upper extremity-specific complication rate of 236.2 per 1,000 fractures for nonoperative management vs. a rate of 307.5 per 1,000 fractures for operative management. Although patients who underwent operative management had no significant differences in 90-day complication rates compared with patients who underwent nonoperative management, researchers noted a higher 1-year complication rate in the operative management group.
Stiffness, chronic regional pain syndrome, median neuropathy, implant-related complications and tendon-relation complications were the five most common upper extremity-specific complications following operative treatment of distal radial fractures, according to results. Researchers found the most common 1-year upper extremity-specific complication to be post-injury stiffness, which was significantly more frequent following operative management.
“The overall 1-year complication rate was significantly higher following operative management compared with nonoperative management regardless of operative procedure. Stiffness was the most common 1-year post-injury complication across all modes of treatment,” Kakar told Healio/Orthopedics. “The overall 1-year post-injury complication rate was the lowest for nonoperative management and was significantly higher following operative management. Given these findings, the decision to proceed with operative intervention in this patient cohort should be carefully considered.” – by Casey Tingle
Disclosures: Kakar reports he receives personal fees from Arthrex and other support from the Bone and Joint Journal and the Journal of Bone and Joint Surgery. Please see the study for all other authors’ relevant financial disclosures.
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