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

Abstract

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.

The factors affecting the redisplacement in distal radius fractures

“…The concept of stability gains importance in the conservative treatment of distal radius fractures. There are many studies investigating the instability criteria in distal radius fractures [17]. It is claimed that; patient age 60 or above, comminution of metaphyseal dorsal cortex, dorsal angulation greater than 20°, shortening of radial length more than 5 mm/positive ulnar variance, associated ulnar fracture, severe osteoporosis, radial inclination less than 15°, joint stepping of more than 2 mm and an enlargement of more than 50% in the joint face are important in instability [12,18].…”

Operative vs conservative treatment in distal radius fractures

“…[ 7 , 8 ] However, when similar fractures occur among the elderly, the most appropriate form of management is less clear due to a number of factors, such as decreased functional demands, higher perioperative risks, poorer bone quality, etc. [ 9 , 10 ]…”