Comparison of treatment outcomes between nonsurgical and surgical treatment of distal radius fracture in elderly: a systematic review and meta-analysis

Ju, Jihui; Jin, Guangzhe; Li, Guan-Xing; Hu, Haiyang; Hou, Ruixing

doi:10.1007/s00423-015-1324-9

Cited by 76 publications

(72 citation statements)

References 29 publications

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“…We found a significant improvement of grip strength in favor of operative treatment, which is in contrast with 2 previous meta-analyses. Ju et al 4 We found no significant difference between treatment groups regarding range of wrist motions.…”

Section: Jama Network Open | Orthopedicsmentioning

confidence: 50%

“…[3][4][5] Recent meta-analyses have focused specifically on patient populations 60 years or older. 4,5 These meta-analyses found no difference in functional outcome between operative and nonoperative treatment in elderly patients. However, the international rate of operative treatment of distal radius fractures has been increasing, despite higher cost and limited functional outcome evidence to support this shift.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Jama Network Open | Orthopedicsmentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

et al. 2020

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“…Surgical treatment of unstable fractures among the elderly has not proven superior to nonoperative treatment regarding functional outcome 64,[113][114][115][116] . However, among an active and slightly younger population (61-80 years), one study has shown a better functional outcome after volar plating compared with non-surgical treatment 117 .…”

Section: Elderly Patientsmentioning

confidence: 99%

Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly

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Wahlgren

Olsson

et al. 2019

The Journal of Bone and Joint Surgery

103

120

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Background: The usage of volar locking plate fixation for distal radial fractures has increased in older patient populations, despite the fact that surgical treatment in the elderly population has not clearly been proven to be superior to nonoperative treatment. The purpose of the present study was to compare nonoperative treatment with volar locking plate fixation with regard to clinical outcome for elderly patients with dorsally displaced distal radial fractures. Methods: In this study, 140 patients were randomly allocated to nonoperative treatment with a plaster splint (n = 72) or volar locking plate fixation (n = 68). The outcome variables were the Patient-Rated Wrist Evaluation (PRWE) score, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire score, EuroQol-5 Dimensions (EQ-5D) score, range of motion, grip strength, radiographic outcomes, and complications. Evaluation was performed at 3 and 12 months by unblinded observers. Results: At 3 months, 122 patients were evaluated, and at 12 months, 119 patients were evaluated. At 3 months, the volar locking plate group, compared with the nonoperative treatment group, had a better median PRWE score (10.3 compared with 35.5 points; p = 0.002), DASH score (14.4 compared with 29.2 points; p = 0.016), and grip strength (71.0% of the uninjured hand compared with 53.9%; p < 0.001). Significant differences in favor of the volar locking plate group remained at 12 months; compared with the nonoperative treatment group, the volar locking plate group had a better median PRWE score (7.5 points compared with 17.5 points; p = 0.014), DASH score (8.3 points compared with 19.9 points; p = 0.028), and grip strength (96.8% compared with 80.0%; p = 0.001). Radiographic measurements favored volar locking plate fixation at 3 and 12 months. Complication rates were similar, with 11% major complications in the nonoperative group compared with 14% major complications in the volar locking plate group (p = 0.606) and 11% minor complications in the nonoperative group compared with 20% minor complications in the volar locking plate group (p = 0.197). Conclusions: The PRWE scores, DASH scores, and grip strength were better for the volar locking plate group compared with the nonoperative group at 3 and 12 months. The complication rates were similar. Our results imply that there is a benefit for the elderly patient with an unstable dorsally displaced distal radial fracture to be treated with a volar locking plate. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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“…There had been a few studies of operative versus non‐operative treatment of distal radius fractures in the elderly (over 60 years of age) published recently, but the results were not conclusive . A meta‐analysis showed that surgery and non‐surgical treatment both had their own advantages and disadvantages . The American Academy of Orthopaedic Surgeons guidelines also did not recommend or oppose the surgical treatment of distal radius fractures in patients over 55 years of age .…”

Section: Introductionmentioning

confidence: 99%

Factors associated with the decision for operative versus conservative treatment of displaced distal radius fractures in the elderly

Yang

Xie

et al. 2019

ANZ Journal of Surgery

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Background: The treatment of senile distal radius fractures had not been clearly defined. The objective of this study was to identify the factors associated with the decision for operative treatment of displaced distal radius fractures in patients aged over 55 years. Methods: Data of 318 patients with displaced distal radius fractures were collected on patient-, fracture-and surgeon-related characteristics that were plausibly related to the decision for operation. Mean comparisons or chi-squared test were used for univariate analysis of the above-mentioned factors, and then multiple logistic regression was used to identify factors associated with the decision for operation. Results: Univariate analysis showed that age, osteoporosis, Charlson score, associated orthopaedic injuries requiring surgery, Orthopaedic Trauma Association (AO) and Fernandez classification, radial height, volar tilt, volar/dorsal comminution, ulnar variance, intra-articular displacement/step-off, associated distal radioulnar joint instability or radiocarpal joint dislocation and subspecialty of treating surgeons had statistically significant association with operative intervention. In the multivariate analysis, the predictors of operative intervention were younger patient age (P = 0.028), associated orthopaedic injuries requiring surgery (P = 0.020), higher AO classification (P = 0.037), higher Fernandez classification (P = 0.041), radial shortening >5 mm (P = 0.020), volar tilt > −10 (P = 0.020), volar/dorsal comminution (P = 0.020), ulnar variance >5 mm (P = 0.023), intra-articular displacement/step-off >2 mm (P = 0.004), associated distal radioulnar joint instability or radiocarpal joint dislocation (P = 0.047) and treatment by an upper extremity specialist (P = 0.038). Conclusion: The decision for surgery was predominantly influenced by the characteristics and severity of the fracture. Patients' age and treatment by an upper extremity specialist were also significant factors associated with a higher likelihood of operative intervention. © 2019 Royal Australasian College of Surgeons ANZ J Surg 89 (2019) E428-E432 ANZJSurg.com © 2019 Royal Australasian College of Surgeons E432Wu et al.

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Comparison of treatment outcomes between nonsurgical and surgical treatment of distal radius fracture in elderly: a systematic review and meta-analysis

Abstract: Surgical and nonsurgical methods produce similar results in the treatment of DRFS in the elderly, and minor objective functional differences did not result an impact on subjective function outcome and quality of life.

Cited by 76 publications

References 29 publications

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly

Factors associated with the decision for operative versus conservative treatment of displaced distal radius fractures in the elderly

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