Wrist Pain and Functionality in Surgical versus Conservative Management of Distal Radius Fractures in the Elderly: A Short-Term Prospective Study
Garrick Gu, BaiJing Qin, Anselm Wong, Douglas Rothkopf.
University of Massachusetts Medical School, Worcester, MA, USA.
Distal radius fractures are frequent injuries of the upper extremity in the geriatric population and can cause profound loss of function, greatly impacting quality of life. Previous literature shows comparable long-term outcomes regardless of treatment modality. Our prospective study aims to demonstrate a safe and efficacious operative management of distal radius fractures that provides better short-term outcomes and return to function in the elderly.
Materials & Methods
From 2017 to 2020, patients age 65 and older with unilateral distal radius fractures without any concomitant polytrauma are included in this prospective study. Patients treated with conservative management with casting or surgical intervention with open reduction internal fixation with volar plating were evaluated at each follow up visit for treatment weeks 1, 3, 6, 12, and 26. At each treatment interval, QuickDASH, wrist range of motion, and pain were assessed to determine level of function and quality of life. Treatment outcomes are compared between the surgical and conservative groups using the t test.
A total of 54 patients in the surgical group (mean age 73.4) and 22 patients in the conservative group (mean age 74.1) were evaluated. During the first six weeks of treatment, the conservative group reported more wrist pain than the surgical group (p=0.005). Starting week 6, the surgical group had significantly better radial (18.5 vs. 10.9, p=0.007) and ulnar deviation (20.8 vs. 11.4, p=0.005), as well as better flexion (47.2 vs. 33.1, p=0.06) and extension (46.7 vs 33.1, p=0.06). At week 12, patients treated with surgery continued to have significantly better wrist extension (57.7 versus 38.5, p=0.005), as well as wrist flexion (58.5 versus 34.0, p=0.0007) compared to the conservative group. Supination and pronation between the treatment groups remained similar. Finally, the surgical group showed better functional results as reflected by better QuickDASH scores than the conservative group at week 6 (33.3 vs 45.2) and week 12 (25.16 vs 37.35).
Surgical intervention of distal radius fracture in the elderly is a safe and effective procedure. It provides better range of motion, as well as pain control and better quality of life in the short-term than conservative treatment. Surgery allows for an earlier return of function. A thorough discussion of the surgical option is imperative to provide the best treatment for distal radius fracture patients over 65.
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