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

Arora, Rohit; Lutz, M.; Deml, Christian; Krappinger, Dietmar; Haug, Luzian; Gabl, M.

doi:10.2106/jbjs.j.01597

Cited by 452 publications

(448 citation statements)

References 23 publications

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“…This use of overall clinical impression to guide decision making may have optimized results for both groups but the overall similarity in outcomes between patient groups (surgery versus nonoperative treatment and union versus malunion) are consistent with results from the randomized trials of Arora and Roumen. 10,23 In our series we were unable to identify any threshold for radiographic parameters beyond which poor function was expected. However, that does not preclude the possibility that such a threshold exists.…”

Section: Discussionmentioning

confidence: 61%

“…Arora et al conducted a randomized trial comparing nonoperative treatment to volar locking plate fixation in 73 patients ≥65 years old with displaced and unstable DRF’s. 23 They demonstrated that although surgery improved radiographic parameters and increased grip strength it did not improve range of motion, pain, or patient-rated outcome at 1 year, and was associated with significantly more complications. Roumen et al evaluated DRF’s in patients ≥55 initially treated with closed reduction and casting.…”

Section: Discussionmentioning

confidence: 97%

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The Impact of Patient Activity Level on Wrist Disability After Distal Radius Malunion in Older Adults

Nelson

Stepan

Osei

et al. 2015

Journal of Orthopaedic Trauma

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Objective To determine if high-activity older adults are adversely affected by distal radius malunion. Design Cross-sectional study. Setting Hand clinics at a tertiary institution. Participants 96 patients ≥60 years old at time of fracture evaluated at least 1 year following distal radius fracture. Intervention Physical Activity Scale of the Elderly (PASE) scores stratified participants into high- and low-activity groups. Malunions were defined radiographically by change of ≥20° of lateral tilt, ≥15° radial inclination, ≥4 mm of ulnar variance, or ≥4 mm intra-articular gap or step-off, compared to the uninjured wrist. Main Outcome Measure Patient-rated disability of the upper-extremity was measured by the QuickDASH and Visual Analog Scales (VAS) for pain/function. Strength and motion measurements objectively quantified wrist function. Results High-activity participants with a distal radius malunion were compared to high-activity participants with well-aligned fractures. There was no significant difference in QuickDASH scores, VAS function, strength, and wrist motion despite statistically, but not clinically relevant, increases in VAS pain scores (difference 0.5, p=0.04) between the groups. Neither PASE score (β= 0.001, 95%CI: −0.002 to 0.004) nor malunion (β=0.133, 95%CI: −0.26 to 0.52) predicted QuickDASH scores in regression modeling after accounting for age, sex, and treatment. Operative management failed to improve outcomes and resulted in decreased grip strength (p=0.05) and more frequent complications (26% vs 7%, p=0.01) when compared to nonoperatively management. Conclusion Even among highly active older adults, distal radius malunion does not impact functional outcomes. Judicious use of operative management is warranted provided heightened complication rates.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 97%

The Impact of Patient Activity Level on Wrist Disability After Distal Radius Malunion in Older Adults

Nelson

Stepan

Osei

et al. 2015

Journal of Orthopaedic Trauma

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“…Recent RCTs have not identified clear recommendations for the optimal treatment in the elderly population 30–32. In a systematic review cast immobilisation had the worst radiographic outcome but the least complications and a comparable functional outcome with surgical treatment options 31. Radiographic alignment after closed reduction and the functional demand of the patient should guide the decision for further operative stabilisation 29…”

Section: Recommendationsmentioning

confidence: 99%

EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures

et al. 2016

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The European League Against Rheumatism (EULAR) and the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) have recognised the importance of optimal acute care for the patients aged 50 years and over with a recent fragility fracture and the prevention of subsequent fractures in high-risk patients, which can be facilitated by close collaboration between orthopaedic surgeons and rheumatologists or other metabolic bone experts. Therefore, the aim was to establish for the first time collaborative recommendations for these patients. According to the EULAR standard operating procedures for the elaboration and implementation of evidence-based recommendations, 7 rheumatologists, a geriatrician and 10 orthopaedic surgeons met twice under the leadership of 2 convenors, a senior advisor, a clinical epidemiologist and 3 research fellows. After defining the content and procedures of the task force, 10 research questions were formulated, a comprehensive and systematic literature search was performed and the results were presented to the entire committee. 10 recommendations were formulated based on evidence from the literature and after discussion and consensus building in the group. The recommendations included appropriate medical and surgical perioperative care, which requires, especially in the elderly, a multidisciplinary approach including orthogeriatric care. A coordinator should setup a process for the systematic investigations for future fracture risk in all elderly patients with a recent fracture. High-risk patients should have appropriate non-pharmacological and pharmacological treatment to decrease the risk of subsequent fracture.

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“…Although the role of fracture displacement in the nonoperative treatment of distal humeral fractures remains unknown, the literature on the treatment of distal radial fractures in the elderly would support the observation that radiographic findings do not correlate with clinical outcomes. 2,9,11 The distal humerus is composed of medial and lateral columns that support the articular segment, which functions as a tie arch. 18 In our study, most of the articular fractures showed some degree of secondary congruence even in the presence of a significant articular step.…”

Section: Discussionmentioning

confidence: 99%

Functional outcomes of distal humeral fractures managed nonoperatively in medically unwell and lower-demand elderly patients

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Faber

King

et al. 2015

Journal of Shoulder and Elbow Surgery

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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

Cited by 452 publications

References 23 publications

The Impact of Patient Activity Level on Wrist Disability After Distal Radius Malunion in Older Adults

The Impact of Patient Activity Level on Wrist Disability After Distal Radius Malunion in Older Adults

EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures

Functional outcomes of distal humeral fractures managed nonoperatively in medically unwell and lower-demand elderly patients

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