Safety and Efficacy of Operative Versus Nonsurgical Management of Distal Radius Fractures in Elderly Patients: A Systematic Review and Meta-analysis

Chen, Yiheng; Chen, Xing‐Long; Li, Zhijie; Yan, Hede; Zhou, Fang; Gao, Weiyang

doi:10.1016/j.jhsa.2015.12.008

Cited by 94 publications

(98 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These findings are also in accordance with those of Chen et al, 5 who reported wrist range of motion did not differ significantly at final follow-up between the 2 treatment groups.…”

Section: Jama Network Open | Orthopedicssupporting

confidence: 92%

See 1 more Smart Citation

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

et al. 2020

View full text Add to dashboard Cite

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)

show abstract

“…These findings are also in accordance with those of Chen et al, 5 who reported wrist range of motion did not differ significantly at final follow-up between the 2 treatment groups.…”

Section: Jama Network Open | Orthopedicssupporting

confidence: 92%

“…Several metaanalyses have been published on the comparison between operative and nonoperative treatment. [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.…”

Section: Introductionmentioning

confidence: 99%

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

et al. 2020

View full text Add to dashboard Cite

show abstract

“…We excluded immature osseous structure of age younger than 20 years. Although DRF more commonly occurs in elderly patients with or without osteoporosis, we excluded those older than 65 years because elderly patients could be relatively satisfied with their overall condition regardless of radiographic outcomes 11 .…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Conservative Treatment for Distal Radius Fractures with or without Ulnar Styloid Fractures

Lee

Park

Baek

et al. 2019

Arch Hand Microsurg

View full text Add to dashboard Cite

“…However, this difference becomes statistically significant when we search for mayor complications (p ¼ 0.2). 9 According to the Mayo Clinic Wrist Score, although 58 patients had excellent or good results, 8 presented satisfactory or 4 poor result. We observed that patients who presented complications tended to present worse outcome.…”

Section: Discussionmentioning

confidence: 99%

“…2 Multiple treatments for DRF have been described for unstable fractures in the eldery patients with satisfactory results, including cast immobilization, external fixation, percutaneous Kirschner wire, and volar plate fixation. 4,7,9,10 However, the old-age group is characterized by osteoporosis that favors this metaphyseal bone fracture. 11 Consequent bone weakening and increased fracture instability are critical in the loss of reduction after close reduction and plaster treatment.…”

mentioning

confidence: 99%

Volar Plate Fixation in Patients Older Than 70 Years with AO Type C Distal Radial Fractures: Clinical and Radiologic Outcomes

et al. 2017

View full text Add to dashboard Cite

Treatment of unstable distal radial fractures (DRFs) in elderly patients is controversial, and considering the increasing life expectancy, their appropriate treatment is of growing importance. Our aim was to analyze the clinical and radiologic outcomes in the elderly patients with AO type C DRF treated with volar locking plate (VLP). Between 2007 and 2011, 572 DRFs were operated on in our hospital with open reduction and internal fixation with VLP. Of these, only 64 patients (66 DRFs) met the selection criteria (AO type C DRF, age> 70 years, minimum 12-month follow-up). Mean follow-up was 28 months. Outcome assessment included range of motion, grip strength, VAS pain, Mayo Clinic Score, and DASH score. Analysis of pre- and postoperative radiographs was performed. Complications were recorded. Statistical analysis was performed comparing the results with the contralateral side. Mean postoperative range of motion of the injured wrist compared with the control contralateral side was 86% for flexion ( < 0.001), 92% for extension ( < 0.001). The average DASH was 12. Mayo Clinic Wrist Score showed 43 excellent results, 15 good, 4 satisfactory, and 4 poor. Articular step-offs were reduced in 34 of 38 wrists. Five (7%) patients required plate removal. The treatment of articular DRF (AO type C) with VLP in the elderly patients achieved greater than 90% of the wrist range of motion and grip strength with no residual pain in greater than 90% of the patients. Therapeutic IV, case series.

show abstract

Safety and Efficacy of Operative Versus Nonsurgical Management of Distal Radius Fractures in Elderly Patients: A Systematic Review and Meta-analysis

Cited by 94 publications

References 28 publications

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

Clinical Outcomes of Conservative Treatment for Distal Radius Fractures with or without Ulnar Styloid Fractures

Volar Plate Fixation in Patients Older Than 70 Years with AO Type C Distal Radial Fractures: Clinical and Radiologic Outcomes

Contact Info

Product

Resources

About