Active older adults with distal radius fractures may benefit from surgical treatment
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Published results showed highly active older adults may consider surgical treatment for distal radius fractures, as chronological age had no association with functional demand.
“Sustaining a [distal radius fracture] may impose severe restrictions on lifestyle for those who are active despite their chronological age. These individuals can benefit from surgical treatment, which enables earlier return to daily function,” the authors wrote. “Individuals with lower functional status or who live sedentary lifestyles are best treated with casting because they can still achieve recovery similar to that of patients who underwent surgery, albeit at a slower pace.”
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In a retrospective secondary analysis of the Wrist and Radius Injury Surgical Trial, researchers assessed Michigan Hand Outcomes Questionnaire (MHQ) scores at 6 weeks, 3 months, 6 months and 1 year among 293 patients older than 60 years of age with unstable distal radius fractures who underwent either casting (n=109) or surgery (n=184). Researchers randomly assigned patients who underwent surgery to volar locking plate, percutaneous pinning or external fixation. Researchers also stratified all patients by chronological age, number of comorbidities and activity status.
Although results showed an association between increased chronological age with increased MHQ scores in the surgery group at all time points, researchers noted increased chronological age was associated with decreased MHQ scores in the casting group at 12 months. Researchers also found an association between high activity and improved MHQ scores in the surgical cohort at 6 weeks and 12 months postoperatively. In the casting group, comorbidities had an association with decreased MHQ scores at all time points, according to results. Researchers found an association between clinically significant differences in MHQ scores with low physical activity, four or more comorbidities or increased age by 15 years.
“Surgeons should assess a patient’s physiological age to determine optimal [distal radius fracture] treatment in the elderly population. Advanced chronological age should not be a deterrent to surgical fixation in a patient with an active lifestyle,” the authors wrote. “Future studies should characterize other patient characteristics that could be associated with a patient’s physiologic age.”
Perspective
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This valuable study is a retrospective analysis of the Wrist and Radius Injury Surgical Trial (WRIST) comparing chronologic vs. physiologic age in distal radius fracture treatment and recovery. Distal radius fractures are among the most common injuries encountered in an orthopedic practice and the incidence is increasing with an increasing elderly population.
Guidelines have been developed to assist physicians in selecting the appropriate treatment for older patients with distal radius fractures. Current guidelines are based on chronologic age and generally recommend cast immobilization rather than surgical intervention for patients aged 65 years and older. However, all patients aged 65 years and older are not the same. Some are physiologically younger, participating in high-demand activities, such as golf, racquet sports and skiing, while others are physiologically older leading lower-demand sedentary lifestyles. High-demand patients usually want to return to their preinjury level of function as quickly as possible. Many orthopedic hand surgeons individualize their treatment based on multiple factors, including activity level, rather than relying on chronologic age alone.
This study found that chronologic age was not an indicator of functional demand and high-demand patients aged 65 years and older should consider surgical intervention rather than cast immobilization for treatment of their distal radius fracture. Advanced chronologic age should not deter surgical treatment in high-demand patients with an active lifestyle. This study validates a treatment approach based on physiologic age and activity level rather than chronologic age alone. In high-demand active patients aged 65 years and older, surgical intervention frequently produces a better outcome than cast immobilization.
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