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

Abstract

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.

Comparison of 24-Month Outcomes After Treatment for Distal Radius Fracture

“…To our knowledge, there are only 8 published reports of 24-month or longer outcomes in older populations, and, of those, only 2 reported intermediate time points. [8][9][10][11][12][13][14]16 Furthermore, no study conducted a concurrent comparison of all 4 currently accepted treatments. Arora et al 8 found no changes in radiographic alignment between 12-week and 4-year assessments of patients aged 70 years and older treated with casting or open reduction and internal fixation.…”

“…Few studies followed older adults longer than 12 months, and those that did only reported results from the final assessment; intermediate outcomes to track the trajectory of recovery were missing. [8][9][10][11][12][13][14][15][16] Long-term outcomes on injuries in older adults are especially germane because today's older generation is living longer and leading more active lives than previous generations. In this era of value-based care and shared decision-making, long-term outcomes help to guide surgeons, patients, and their families through understanding the benefits and risks of each treatment.…”