Unstable distal radius fractures in the elderly patients: does volar locking plating system prevent secondary displacement?

ABSTRACT Purpose To evaluate the use of internal distraction plating for the management of comminuted, intra-articular distal radius fractures in patients over 60 years of age at two level one trauma centers. Our hypothesis was that distraction plating of comminuted distal radius fractures in the elderly would result in acceptable outcomes regarding range of motion, disabilities of the arm, shoulder and hand (DASH) score, and radiographic parameters and would thereby provide the upper extremity surgeon with another option for the treatment of these fractures. Materials and methods A retrospective review was performed on 33 patients over 60 years of age with comminuted distal radius fractures treated by internal distraction plating at two level 1 trauma centers. Patients were treated with internal distraction plating across the radiocarpal joint. At the time of final follow-up, radiographs were evaluated for ulnar variance, radial inclination, and palmar tilt. Range of motion, complications and DASH scores were also obtained. Results Thirty-three patients with a mean age of 70 years were treated with distraction plating for comminuted distal radius fractures. At final follow-up, all fractures had healed and radiographs demonstrated mean palmar tilt of 5° and mean positive ulnar variance of 0.6 mm. Mean radial inclination was 20°. Mean values for wrist flexion and extension were 46° and 50° respectively. Mean pronation and supination were 79° and 77° respectively. At the final follow-up, the mean DASH score was 32. Conclusion In the elderly, distraction plating is an effective method of treatment for comminuted, osteoporotic distal radius fractures. Level of evidence Therapeutic, Level IV (Retrospective case series). Richard MJ, Katolik LI, Hanel DP, Wartinbee DA, Ruch D. Distraction Plating for the Treatment of Highly Comminuted Distal Radius Fractures in Elderly Patients. The Duke Orthop J 2013;3(1):93-98.

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Treatment of the Distal Radius Fractures in the Elderly Patients

Journal of the Korean Society for Surgery of the Hand ◽

10.12790/jkssh.2013.18.2.95 ◽

2013 ◽

Vol 18 (2) ◽

pp. 95

Author(s):

Young Do Koh ◽

Dong Joon Kim ◽

Jae Kwang Kim

Keyword(s):

Elderly Patients ◽

Distal Radius ◽

The Elderly ◽

Distal Radius Fractures ◽

Radius Fractures

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Volar locking plate vs epibloc system for distal radius fractures in the elderly

Injury ◽

10.1016/j.injury.2016.07.056 ◽

2016 ◽

Vol 47 ◽

pp. S84-S90 ◽

Cited By ~ 5

Author(s):

Giuseppe Solarino ◽

Giovanni Vicenti ◽

Antonella Abate ◽

Massimiliano Carrozzo ◽

Girolamo Picca ◽

...

Keyword(s):

Distal Radius ◽

Locking Plate ◽

The Elderly ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures

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Distal Radius Fractures in the Elderly

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-15-00676 ◽

2017 ◽

Vol 25 (3) ◽

pp. 179-187 ◽

Cited By ~ 27

Author(s):

L. Scott Levin ◽

Joshua C. Rozell ◽

Nicholas Pulos

Keyword(s):

Distal Radius ◽

The Elderly ◽

Distal Radius Fractures ◽

Radius Fractures

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Treatment of Distal Radius Fractures in Women Older than 80 Years: A Preliminary Report of Functional and Radiographic Outcomes after Open Reduction and Internal Fixation

Journal of Hand and Microsurgery ◽

10.1055/s-0041-1729439 ◽

2021 ◽

Author(s):

Lili E. Schindelar ◽

Richard M. McEntee ◽

Robert E. Gallivan ◽

Brian Katt ◽

Pedro K. Beredjiklian

Keyword(s):

Internal Fixation ◽

Distal Radius ◽

Functional Outcomes ◽

Open Reduction ◽

The Elderly ◽

Distal Radius Fractures ◽

Implant Design ◽

Complication Rates ◽

Radius Fractures ◽

Hardware Failures

Abstract Background Distal radius fractures are one of the most common fractures seen in the elderly. The management of distal radius fractures in the elderly, especially patients older than 80 years, has not been well defined. The purpose of this study was to evaluate operative treatment of distal radius fractures in patients older than 80 years to determine functional outcomes and complication rates. Materials and Methods A retrospective review was performed to identify patients 80 years or older who were treated for a distal radius fracture with open reduction and internal fixation (ORIF). Medical records were reviewed for demographics, medical history, functional outcomes including quick Disabilities of the Arm, Shoulder, and Hand (qDASH), radiographs, and postoperative complications. Results There were 40 patients included for review. Average age was 84 years. The preoperative qDASH score was 69. At 6 months follow-up, the postoperative qDASH score was 13 (p < 0.001). There were five (12.5%) complications reported postoperatively. All fractures healed with adequate radiographic alignment and there were no hardware failures. Conclusion Distal radius fractures in patients older than 80 years treated with ORIF have good functional outcomes and low complication rates. Increased functionality and independence of the elderly, as well as updated implant design can lead to the effective surgical management of these patients. When indicated from a clinical perspective, operative fixation of distal radius fractures should be considered in patients older than 80 years.

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Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417727139 ◽

2017 ◽

Vol 43 (2) ◽

pp. 142-147 ◽

Cited By ~ 27

Author(s):

Daniel Martinez-Mendez ◽

Alejandro Lizaur-Utrilla ◽

Joaquin de-Juan-Herrero

Keyword(s):

Conservative Treatment ◽

Elderly Patients ◽

Distal Radius ◽

Articular Surface ◽

Distal Radius Fractures ◽

Volar Plating ◽

Radius Fractures ◽

Level Of Evidence ◽

Loss Of Reduction

We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures. Level of evidence: I

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Is a short arm cast appropriate for stable distal radius fractures in patients older than 55 years? A randomized prospective multicentre study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417690464 ◽

2017 ◽

Vol 42 (5) ◽

pp. 487-492 ◽

Cited By ~ 7

Author(s):

M. J. Park ◽

J. P. Kim ◽

H. I. Lee ◽

T. K. Lim ◽

H. S. Jung ◽

...

Keyword(s):

Multicentre Study ◽

Distal Radius Fracture ◽

Distal Radius ◽

The Elderly ◽

Plaster Cast ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Radius Fractures ◽

Cast Immobilization ◽

Level Of Evidence

We conducted a prospective randomized, multicentre study to compare short arm and long arm plaster casts for the treatment of stable distal radius fracture in patients older than 55 years. We randomly assigned patients over the age of 55 years who had stable distal radius fracture to either a short arm or long arm plaster cast at the first review 1 week after their injury. Radiographic and clinical follow-up was conducted at 1, 3, 5, 12 and 24 weeks following their injury. Also, degree of disability caused by each cast immobilization was evaluated at the patient’s visit to remove the cast. There were no significant differences in radiological parameters between the groups except for volar tilt. Despite these differences in volar tilt, neither functional status as measured by the Disabilities of the Arm, Shoulder and Hand, nor visual analogue scale was significantly different between the groups. However, the mean score of disability caused by plaster cast immobilization and the incidence rate of shoulder pain were significantly higher in patients who had a long plaster cast. Our findings suggest that a short arm cast is as effective as a long arm cast for stable distal radius fractures in the elderly. Furthermore, it is more comfortable and introduces less restriction on daily activities. Level of evidence: II

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