J Korean Soc Surg Hand.  2015 Jun;20(2):43-50. 10.12790/jkssh.2015.20.2.43.

Comparative Study of Outcomes between Operative and Non-Operative Treatment of Unstable Distal Radius Fracture in the Elderly Patients

• Kim JM
• Seo HJ
• Jeon YD
• Lee HM
• Son JH

• KMID: 2194098
• DOI: http://doi.org/10.12790/jkssh.2015.20.2.43

Abstract

PURPOSE
The goal of this retrospective study is to compare radiologic outcome and clinical outcome between operative and non-operative treatment of unstable distal radius fracture in patients over 65-year-old.
METHODS
From December 2006 to December 2011, 114 patients over 65-year-old were enrolled in the present study. 45 patients underwent non-operative treatment, and 69 patients underwent operative treatment. We retrospectively reviewed radiologic results and clinical results and then compared the two groups. Radiologic results include radial inclination (RI), volar tilt angle (VT) and radial shortening (RS) shown on the last radiograph and clinical results including disabilities of the arm, shoulder and hand (DASH) scores, modified Mayo wrist score (MMWS), and range of motion (ROM) of wrist.
RESULTS
All cases presented bone-union. Among the patients who received non-operative treatments, average RI of 15.5degrees, average VT of 14.1degrees, average RS of 5.3 mm, The patients who received operative treatments showed average volar tilt of 3.9degrees, average VT of 18.2degrees, and average RS of 1.1 mm. RS showed a significant difference (p<0.05). At Clinical evaluation, DASH score, MMWS score, the ROM of wrist joint did not show significant difference (p>0.05).
CONCLUSION
Our results suggest that non-operative treatment is initially recommended in patients over 65 years who have an unstable distal radius fracture in terms of functional results.

Keyword

Unstable distal radius fracture; Operative treatment; Non-operative treatment

MeSH Terms

Aged*
Arm
Hand
Humans
Radius Fractures*
Range of Motion, Articular
Retrospective Studies
Shoulder
Wrist
Wrist Joint

Figure

• 

  Fig. 1. Radiographs of 84-yerar-old female who received conservative treatment. (A) Radiograph shows 1.8mm radial shortening and 24.7° dorsal tilting. (B) Closed reduction and sugar tong splint was applied. Radial shortening reduced to 0 mm and dorsal tilting decreased to 6.4°. (C) Twelve month follow-up radiographs shows 1.2 mm radial shortening and 18.5° dorsal tilting.

• 

  Fig. 2. Radiographs of 76-yerar-old female who underwent operative treatment. (A) Preoperative radiograph shows 5.4 mm radial shortening and 11.7° dorsal tilting. (B) Open reduction and volar locking plate was applied. Radial shortening reduced to 0mm and dorsal tilting decreased to 2.2°. (C) Seven month follow-up radiographs shows 0.5 mm radial shortening and 4.8° dorsal tilting.

• 

  Fig. 3. Radiographs of 72-yerar-old female who underwent operative treatment. (A) Preoperative radiograph shows 2.0 mm radial shortening and 4.8° dorsal tilting. (B) Closed reduction and K-wire fixation was done. Radial shortening reduced to 1.7 mm and dorsal tilting decreased to 4.5°. (C) Eight month follow-up radiographs shows 2 mm radial shortening and 3.1° dorsal tilting.

Reference

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