Comparison Between External Fixation and Cast Treatment in the Management of Distal Radius Fractures in Patients Aged 65 Years and Older

Aktekin, Cem Nuri; Altay, Murat; Gursoy, Zeki; Aktekin, Lale Akbulut; Öztürk, Akif Muhtar; Tabak, Abdullah Yalçın

doi:10.1016/j.jhsa.2010.01.028

Cited by 51 publications

(48 citation statements)

References 28 publications

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“…In a prospective, randomised study by Aktekin et al, 46 patients ≥65 years old were treated with either an external fixator or plaster cast and were followed up for 25 months. While no difference was found between the groups with respect to the grip strength and QDASH scores, the radiological values of the group that underwent surgery were reported to be superior 13 . Additionally, Young et al, followed up 25 patients ≥60 years old with plaster casts for 34 months and obtained pleasing results 14 .…”

Section: Discussionmentioning

confidence: 99%

Cast immobilization versus volar locking plate fixation of AO type C distal radial fractures in patients aged 60 years and older

Zengin¹,

Özcan²,

Aslan³

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to evaluate the efficacy of conservative treatment (cast immobilization) for complex intra-articular distal radius fractures (AO type C) in elderly patients and to determine whether or not the application of a volar locking plate (VLP) is necessary.MethodsA retrospective study on patients treated at two different clinics was conducted between 2014 and 2016. A total of 49 elderly patients ≥60 years old were treated either operatively with volar locking plate fixation (n = 25; 7 males and 18 females; mean age: 66.6 ± 7.4 years) or conservatively with cast immobilisation (n = 24; 7 males and 17 females; mean age: 68.9 ± 8.7 years) for complex intra-articular distal fractures. Clinical, functional and radiological evaluations were conducted at the final follow-up examinations of the patients.ResultsThere was no statistically significant difference between the two groups of patients with respect to the follow-up periods, gender, age and fracture type (p > 0.05). At the end of mean follow-up time of 16 months the grip strength (p = 0.03), radial tilt (p = 0.06), radial inclination (p = 0.01), radial height (p = 0.01) and articular step-off (p = 0.02) were significantly better in the volar locking plate group, while there was no significant difference between the functional results (based on the Quick Disabilities of the Arm, Shoulder and Hand score) (p = 0.8) and range of motion. The grip strength was significantly higher in the VLP group when compared to the cast group (p = 0.03).ConclusionThe results of this study suggest that the locking plate fixation for the complex intra-articular distal radius fractures provides better results for the grip strength and radiographic parameters than cast immobilization in patients ≥60 years old, while no difference was found between the clinical and functional results.Level of EvidenceLevel III, Therapeutic Study.

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Section: Discussionmentioning

confidence: 99%

Cast immobilization versus volar locking plate fixation of AO type C distal radial fractures in patients aged 60 years and older

Zengin¹,

Özcan²,

Aslan³

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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“…Complication rate was reported in 19 studies, including 8 RCTs 31,35,36,38,[46][47][48][49] and 11 observational studies. [32][33][34]37,[39][40][41][42]45,50,51 The overall pooled effect showed no difference in complication rate between operative and nonoperative treatment with an RR of 1.03 (95% CI, 0.69- For studies that did not present characteristics for treatment groups separately, the numbers presented are for the overall study group, and the cells are merged.…”

Section: Primary Outcome Measuresmentioning

confidence: 96%

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

et al. 2020

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IMPORTANCENo consensus has been reached to date regarding the optimal treatment for distal radius fractures. The international rate of operative treatment has been increasing, despite higher costs and limited functional outcome evidence to support this shift. OBJECTIVESTo compare functional, clinical, and radiologic outcomes after operative vs nonoperative treatment of distal radius fractures in adults. DATA SOURCES The PubMed/MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception to June 15, 2019, for studies comparing operative vs nonoperative treatment of distal radius fractures. STUDY SELECTION Randomized clinical trials (RCTs) and observational studies reporting on the following: acute distal radius fracture with operative treatment (internal or external fixation) vs nonoperative treatment (cast immobilization, splinting, or bracing); patients 18 years or older; and functional outcome. Studies in a language other than English or reporting treatment for refracture were excluded. DATA EXTRACTION AND SYNTHESIS Data extraction was performed independently by 2 reviewers. Effect estimates were pooled using random-effects models and presented as risk ratios (RRs) or mean differences (MDs) with 95% CIs. Data were analyzed in September 2019. MAIN OUTCOMES AND MEASURES The primary outcome measures included medium-term functional outcome measured with the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the overall complication rate after operative and nonoperative treatment.RESULTS A total of 23 unique studies were included, consisting of 8 RCTs and 15 observational studies, that described 2254 unique patients. Among the studies that presented sex data, 1769 patients were women [80.6%]. Overall weighted mean age was 67 [range, 22-90] years). The RCTs included 656 patients (29.1%); observational studies, 1598 patients (70.9%). The overall pooled effect estimates the showed a significant improvement in medium-term (Յ1 year) DASH score after operative treatment compared with nonoperative treatment (MD,]; P = .005; I 2 = 84%). No difference in complication rate was observed (RR, 1.03 [95% CI, 0.69-1.55]; P = .87; I 2 = 62%). A significant improvement in grip strength was noted after operative treatment, measured in kilograms (MD, 2.73 [95% CI,]; P = .04; I 2 = 79%) and as a percentage of the unaffected side (MD, 8.21 [95% CI,]; P = .007; I 2 = 76%). No improvement in mediumterm DASH score was found in the subgroup of studies that only included patients 60 years or older (MD, −0.98 [95% CI, −3.52 to 1.57]; P = .45; I 2 = 34%]), compared with a larger improvement in (continued)

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“…Aketin et al described similar findings in a retrospective study with patients older than 65 years. 24 In complex intra-articular DRFs with great metaphyseal void, additional intrafragmentary K-wires are required to directly maintain fracture reduction. Biomechanical studies have proven to increase fracture stability using supplementary K-wires.…”

Section: External Fixationmentioning

confidence: 99%

Aspects of Current Management of Distal Radius Fractures in the Elderly Individuals

Arora

Gabl

Erhart

et al. 2011

Geriatr Orthop Surg Rehabil

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Diatal radius fractures (DRFs) are typical fractures of relatively fit persons with osteoporotic bone who remain active into older age. Traditionally, DRFs in older patients have been treated with closed reduction and cast immobilization. Considering the increasing life expectancy of the elderly population, appropriate management of these fractures is of growing importance. Decision making for surgical or nonsurgical approach to osteoporotic DRFs is difficult. These decisions are often made based on the data from treatments of much younger patients. The current literature concerning the treatment of DRFs in the elderly individuals is more controversial. Some investigators have recommended open reduction internal fixation (ORIF) as treatment for unstable DRFs in older patients, while others have suggested that elderly patients should be treated nonsurgically even if there is an unstable fracture situation because fracture reduction is not associated with functional outcomes as in younger patients. This article reviews the different treatment options for DRFs in the elderly individuals reported in the recent literature.

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Comparison Between External Fixation and Cast Treatment in the Management of Distal Radius Fractures in Patients Aged 65 Years and Older

Cited by 51 publications

References 28 publications

Cast immobilization versus volar locking plate fixation of AO type C distal radial fractures in patients aged 60 years and older

Cast immobilization versus volar locking plate fixation of AO type C distal radial fractures in patients aged 60 years and older

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

Aspects of Current Management of Distal Radius Fractures in the Elderly Individuals

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