• J Orthop Trauma · Apr 2009

    Comparative Study Controlled Clinical Trial

    A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating.

    • Rohit Arora, Markus Gabl, Martin Gschwentner, Christian Deml, Dietmar Krappinger, and Martin Lutz.
    • Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria. rohit.arora@uki.at
    • J Orthop Trauma. 2009 Apr 1;23(4):237-42.

    ObjectivesTo compare final functional and radiographic outcomes of closed reduction and casting (CAST) with open reduction and internal fixation (ORIF) with palmar locking plate for unstable Colles type distal radius fractures (DRFs) in low-demand patients older than 70 years.DesignRetrospective, clinical study.SettingLevel 1 university trauma center.PatientsOver a mean period of 4 years and 7 months, 130 consecutive patients older than 70 years were treated for an unstable dorsally displaced DRF of which 114 or 87% were followed for 1 year or longer.InterventionORIF (n = 53) using volar locking plate or closed reduction and casting (n = 61).Main Outcome MeasurementsObjective and subjective functional results (active range of motion; grip strength; disabilities of the arm, shoulder and hand (DASH) score; patient-rated wrist evaluation (PRWE) score; visual analog scale; and Green and O'Brien score) and radiographic assessment (dorsal tilt, radial inclination, radial shortening, fracture union, and posttraumatic arthritis) were assessed.ResultsAt final follow-up, there was no significant difference between the 2 groups for mean ranges of motion, grip strength, DASH score, PRWE score, and Green and O'Brien score. Pain level was significantly less for the patients in the CAST group. An obvious clinical deformity was present in 77% of cast group and none in the ORIF group. At final follow-up, in the ORIF group, there was a mean loss of dorsal tilt of 1.3 degrees, radial inclination of 0.3 degrees, and radial length of 0.5 mm compared with the postoperative measurements. No primary acceptable reduction was achieved in 44% of the CAST group. At final follow-up, in the CAST group, dorsal tilt, radial inclination, and radial shortening averaged -24.4 +/- 12 degrees, 19.2 +/- 6.5 degrees, and +3.9 +/- 2.7 mm, respectively. Malunion occurred in 89% primarily reduced fractures. Dorsal tilt, radial inclination, and radial shortening were significantly better in the ORIF group.ConclusionsRadiographic results (dorsal tilt, radial inclination, and radial shortening) after unstable dorsally displaced DRFs are significantly better in patients treated by ORIF using a volar fixed-angle plate rather than those treated by cast immobilization (P < 0.05). At a mean follow-up time of 4 years and 7 months, the clinical outcomes of active range of motion, the PRWE, DASH, and Green and O'Brien scores do not differ between the 2 methods of treatment. The pain level was significantly less in the CAST group (P < 0.05), and this group experienced no complications. There was no difference between the subjective and functional outcomes for the surgical and the nonsurgical treatments in a cohort of patients older than 70 years. Unsatisfactory radiographic outcome in older patients does not necessarily translate into unsatisfactory functional outcome. Nonoperative treatment may be the preferred method of treatment in this age group.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…