Effectiveness of Non-Operative Treatment vs. Operative Treatment of
Unstable Distal Radius Fractures in the Elderly
Abstract
Background: There has been an ongoing debate on how to treat patients over 65 with unstable distal radius fractures. The purpose of this systematic analysis is to review the literature and determine if nonoperative care in the form of casting vs. operative care can be as effective in this specific population.
Methods: An exhaustive search of available medical literature using the following databases: MEDLINE-Ovid, CINAHL, Web of Science and Clinical Key using search terms fracture fixation, radius fracture, aged, non–operative and unstable was undertaken. Outcomes of interest included Disabilities of the Arm, Shoulder, and Hand (DASH) scores and Patient related Wrist Evaluation (PRWE) to determine functionality, wrist range-of-motion (ROM), pain, grip strength, and radiographic findings. The purpose was to determine outcomes of these various factors comparing the nonoperative vs. operative approaches in those patients over 65 years old. GRADE was utilized in assessing the quality of evidence.
Results: One prospective randomized study6 and two retrospective studies7,4 were analyzed. The prospective study demonstrated that there was no difference in functionality of the fractured wrist between the operative and conservatively managed groups at one year after sustaining unstable distal radius fracture. Both of the retrospective studies also concluded that at one year after the initial fracture there was no difference in functional status between the groups. Complications occurred less frequently in the conservatively managed patients across all three studies 6,7,4 whereas grip strength and radiographic findings were improved in the operative group.
Conclusion: At one year follow up examination of the non-operative group vs. operative group in the treatment of unstable distal radius fractures, grip strength and radiographic findings were better in the operative group. In addition, complications were less in the non-operative group. Functionality based on DASH scores, ROM and pain in those over age 65 showed no significant differences. Therefore, since functionality is similar with either intervention, in patients where surgical risks are high, the non-operative approach can be considered.
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REVIEWED STUDIES:
Egol KA, Walsh M, Romo-Cardoso S, et al. Distal radial fractures in the elderly: operative compared with nonoperative treatment. J BONE JOINT SURG (AM). 2010;92-A:1851-1857 7p.
Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. Journal of Bone & Joint Surgery – American Volume. 2011;93:2146-2153.
Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma. 2009;23:237-242.
AUTHOR: Shannon Donegan graduated from Pacific University, School of PA Studies in August 2017.