Association of Open Reduction and Internal Fixation With Volar Locking Plate for Distal Radius Fractures With Patient-Reported Outcomes in Older Adults

Abstract

ImportanceRandomized clinical trials (RCTs) and meta-analyses have reported inconsistent conclusions regarding optimal distal radius fracture (DRF) treatment in older adults and are limited due to the inclusion of cohort studies with small sample sizes. A network meta-analysis (NMA) addresses these limitations by only synthesizing direct and indirect evidence from RCTs and may clarify optimal DRF treatment in older adults.ObjectiveTo examine DRF treatment results in optimal short-term and intermediate-term patient-reported outcomes.Data SourcesSearches of MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials were conducted for RCTs that investigated DRF treatment outcomes in older adults between January 1, 2000, and January 1, 2022.Study SelectionRandomized clinical trials including patients with a mean age of 50 years or older that compared the following DRF treatments were eligible for inclusion: casting, open reduction and internal fixation with volar lock plating (ORIF), external fixation, percutaneous pinning, and nail fixation.Data Extraction and SynthesisTwo reviewers independently completed all data extraction. An NMA aggregated all direct and indirect evidence among DRF treatments. Treatments were ranked by surface under the cumulative ranking curve score. Data are reported as standard mean differences (SMDs) and 95% CIs.Main Outcomes and MeasuresThe primary outcome was short-term (≤3 months) and intermediate-term (>3 months to 1 year) Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores. Secondary outcomes included Patient-Rated Wrist Evaluation (PRWE) scores and 1-year complication rates.ResultsIn this NMA, 23 RCTs consisting of 3054 participants (2495 women [81.7%]) with a mean (SD) age of 66 (7.8) years were included. At 3 months, DASH scores were significantly lower for nail fixation (SMD, −18.28; 95% CI, −29.93 to −6.63) and ORIF (SMD, −9.28; 95% CI, −13.90 to −4.66) compared with casting. The PRWE scores were also significantly lower for ORIF (SMD, −9.55; 95% CI, −15.31 to −3.79) at 3 months. In the intermediate term, ORIF was associated with lowered DASH (SMD, −3.35; 95% CI, −5.90 to −0.80) and PRWE (SMD, −2.90; 95% CI, −4.86 to −0.94) scores. One-year complication rates were comparable among all treatments.Conclusions and RelevanceThe findings of this NMA suggest that ORIF may be associated with clinically significant improvements in short-term recovery compared with casting for multiple patient-reported outcomes measures with no increase in 1-year complication rates. Shared decision-making with patients may be useful to identify patient preferences regarding recovery to determine optimal treatment.

Wrist Radiographic Indices and Patients’ Performance Following Three Surgical Methods for Management of Distal Radius Fractures: A Randomized Single-Blind Controlled Trial

“…A recent network meta-analysis compared short-term (up to 3 months) and intermediate-term (3 to 12 months) of DASH and PRWE scores following different treatment approaches of distal radial fractures and reported that internal fixation with volar lock plating made no increase in 1-year complication rates compared to other treatment options. They proposed shared decision-making with patients to identify patient preferences regarding recovery to determine optimal treatment [24].…”

Is fracture management merely a physical process? Exploring the psychological effects of internal and external fixation

“…Other studies on postoperative QoL found that increases in PCS and MCS scores mostly occur within the first six months postoperatively [ 50 , 51 ]. Based on stable reduction, both internal and external fixation could result in satisfactory fracture recovery in the short term postoperatively [ 4 – 8 ]. However, the time it takes for patients to return to their previous functional status in society varies.…”

“…Treatment methods for fractures have notably progressed with continuous advancements in medical technology. Internal and external fixations are the two commonly used surgical approaches for stabilizing the fracture site and promoting healing and recovery [ 4 – 8 ]. However, besides the physical recovery process, the psychological well-being of fracture patients is the other important dimension that should be carefully considered.…”

Wrist & Hand

“…To address these issues, authors from Ann Arbor (Michigan, USA) conducted a network meta-analysis (NMA) using data from RCTs conducted between 2000 and 2022 in older adults aged 50 years and over. 1 The advantage of a NMA is that it allows for indirect comparison, so by using a range of studies comparing A versus B, and A versus C, the benefit of B versus C can also be calculated. The study assesses patient-reported outcome measures (PROMs) like Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores.…”