Clinical and functional analysis of closed reduction-plastering and volar locking plate methods in distal radius fractures in patients over 60 years of age
Abstract
Aim: Many different methods have been described in the treatment of distal radius fractures (DRF) in the elderly population, and which one is the better method is a matter of debate among orthopedic surgeons. The aim of this study was to compare the results of closed reduction and plastering (CRP) and volar locking plate (VLP), which are used in the treatment of DRF in the elderly population.
Materials and Methods: Between January 2019 and December 2020, 36 patients with DRF aged > 60 years were evaluated retrospectively. There were 19 patients in the CRP group and 17 patients in the VLP group. Wrist flexion, extension, pronation, supination, ulnar deviation, and radial deviation degrees and grip strength were measured in the first year of their treatment. The patients were evaluated functionally by patient-rated wrist evaluation (PRWE), modified Green and O'Brien score (MGOS), and resting and stress visual analogue scale (VAS).
Results: In both groups, similar ROM values were obtained and no significant difference was observed. While the PRWE score was 17.5 ± 5.5 in the CRP group and 12.5 ± 4.8 in the VLP group, the MGOS score was 83.0 ± 7.4 in the CRP group and 86.8 ± 12.6 in the VLP group, and the scores were not significantly different (p = 0.802, p = 0.315). While there was almost no pain in both groups at rest, more pain was felt in the VKP group under stress. While grip strength was 20.9 ± 6.4 kg in the CRP group, it was 22.2 ± 6.8 kg in the VLP group, and there was no significant difference compared to the contralateral wrist.
Conclusion: There is no clinical and functional difference between CRP and VLP in the one-year period after DRF treatment in the patient population aged > 60 years. Treatment should be planned according to the functional capacity of the patient.
References
- Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin 2012;28(2):113-25.
- Crilly RG, Delaquerrière Richardson L, Roth JH, Vandervoort AA, Hayes KC, Mackenzie RA. Postural stability and Colles' fracture. Age Ageing 1987;16(3):133-8.
- Lafontaine M, Delince P, Hardy D, Simons M. Instability of fractures of the lower end of the radius: apropos of a series of 167 cases. Acta Orthop Belg 1989;55(2):203–16.
- Lutz K, Yeoh KM, MacDermid JC, Symonette C, Grewal R. Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older. J Hand Surg Am 2014;39(7):1280-6.
- Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. 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. J Orthop Trauma 2009;23(4):237-42.
- Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 2011;93(23):2146-53.
- Egol KA, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N. Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Joint Surg Am 2010;92(9):1851-7.
- Aktekin CN, Altay M, Gursoy Z, Aktekin LA, Ozturk AM, Tabak AY. Comparison between external fixation and cast treatment in the management of distal radius fractures in patients aged 65 years and older. J Hand Surg Am 2010;35(5):736-42.
- Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC. A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am 2011;36(5):824–35.
- Ju JH, Jin GZ, Li GX, Hu HY, Hou RX. Comparison of treatment outcomes between nonsurgical and surgical treatment of distal radius fracture in elderly: a systematic review and meta-analysis. Langenbecks Arch Surg 2015;400(7):767–79.
- Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am 2000;25(1):19-28.
- Barton T, Chambers C, Bannister G. A comparison between subjective outcome score and moderate radial shortening following a fractured distal radius in patients of mean age 69 years. J Hand Surg Eur Vol 2007;32(2):165-9.
- Martinez-Mendez D, Lizaur-Utrilla A, de-Juan-Herrero J. Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating. J Hand Surg Eur Vol 2018;43(2):142-7.
- MacDermid JC, Richards RS, Donner A, Bellamy N, Roth JH. Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture. J Hand Surg Am 2000;25(2):330-40.
- Green DP, O’Brien ET. Open reduction of carpal dislocations: indications and operative techniques. J Hand Surg Am 1978;3(3):250–65.
- Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am 1994;19(2):325-40.
- Villar RN, Marsh D, Rushton N, Greatorex RA. Three years after Colles’ fracture. A prospective review. J Bone Joint Surg Br 1987;69(4):635-8.
- Porter M, Stockley I. Fractures of the distal radius. Intermediate and end results in relation to radiologic parameters. Clin Orthop Relat Res 1987;(220):241-52.
- Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am 2006;31(3):359-65.
- Combined Randomised and Observational Study of Surgery for Fractures in the Distal Radius in the Elderly (CROSSFIRE) Study Group, Lawson A, Naylor JM, Buchbinder R, Ivers R, Balogh ZJ, et al. Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial. JAMA Surg 2021;156(3):229-37.
- Hassellund SS, Williksen JH, Laane MM, Pripp A, Rosales CP, Karlsen Ø, et al. Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures. Bone Joint J 2021;103-B(2):247-55.
- Chan YH, Foo TL, Yeo CJ, Chew WY. Comparison between cast immobilization versus volar locking plate fixation of distal radius fractures in active elderly patients, the Asian perspective. Hand Surg 2014;19(1):19-23.
60 yaş üstü hastalardaki distal radius kırıklarında kapalı redüksiyon-alçılama ile volar kilitli plak yöntemlerinin klinik ve fonksiyonel analizi
Abstract
Amaç: Yaşlı popülasyonda meydana gelen distal radius kırıklarının (DRK) tedavisinde pek çok farklı yöntem tanımlanmış olup hangisinin daha iyi bir yöntem olduğu ortopedik cerrahlar arasında tartışma konusudur. Bu çalışmanın amacı yaşlı popülasyondaki DRK tedavisinde tercih edilen kapalı redüksiyon-alçılama (KRA) ve açık redüksiyon-internal fiksasyon ile volar kilitli plak (VKP) tedavilerinin sonuçlarını karşılaştırmaktır.
Gereç ve Yöntem: Ocak 2019-Aralık 2020 tarihleri arasında > 60 yaş DRK bulunan 36 hasta retrospektif olarak değerlendirildi. KRA grubunda 19, VKP grubunda ise 17 hasta mevcuttu. Hastaların tedavilerinin birinci yılında el bileği eklem hareket açıklıkları ölçüldü. El dinamometresi yardımıyla el bileği kavrama gücüne bakıldı. Ayrıca hastalar patient-rated wrist evaluation (PRWE), modified Green ve O'brien score (MGOS), istirahat ve stres visual analogue scale (VAS) ile fonksiyonel olarak değerlendirildi.
Bulgular: Her iki grupta da takiplerinin birinci yılında el bilekte benzer eklem hareket açıklığı değerleri elde edilmiş olup anlamlı bir fark görülmedi. PRWE skoru, KRA grubunda 17,5 ± 5,5, VKP grubunda 12,5 ± 4,8 iken MGOS skoru KRA grubunda 83,0 ± 7,4 VKP grubunda 86,8 ± 12,6 bulunmuş olup her iki skor arasındaki fark istatistiksel olarak anlamlı değildi (p=0,802, p=0,315). İstirahat anında her iki grupta da neredeyse hiç ağrı yok iken stres altında VKP grubunda daha çok ağrı hissedilmiştir. Kavrama gücü KRA grubunda 20,9 ± 6,4 kg iken VKP grubunda 22,2 ± 6,8 kg ölçülmüş olup sağlam el bileğine göre anlamlı fark bulunamadı.
Sonuç: 60 yaş üstü hasta popülasyonundaki DRK tedavi sonrası bir yıllık süreçte KRA ve VKP yöntemleri arasında klinik ve fonksiyonel sonuçlar açısından fark bulunmamaktadır. Hastanın fonksiyonel kapasitesine göre tedavi planlaması düşünülmelidir.
References
- Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin 2012;28(2):113-25.
- Crilly RG, Delaquerrière Richardson L, Roth JH, Vandervoort AA, Hayes KC, Mackenzie RA. Postural stability and Colles' fracture. Age Ageing 1987;16(3):133-8.
- Lafontaine M, Delince P, Hardy D, Simons M. Instability of fractures of the lower end of the radius: apropos of a series of 167 cases. Acta Orthop Belg 1989;55(2):203–16.
- Lutz K, Yeoh KM, MacDermid JC, Symonette C, Grewal R. Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older. J Hand Surg Am 2014;39(7):1280-6.
- Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. 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. J Orthop Trauma 2009;23(4):237-42.
- Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 2011;93(23):2146-53.
- Egol KA, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N. Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Joint Surg Am 2010;92(9):1851-7.
- Aktekin CN, Altay M, Gursoy Z, Aktekin LA, Ozturk AM, Tabak AY. Comparison between external fixation and cast treatment in the management of distal radius fractures in patients aged 65 years and older. J Hand Surg Am 2010;35(5):736-42.
- Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC. A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am 2011;36(5):824–35.
- Ju JH, Jin GZ, Li GX, Hu HY, Hou RX. Comparison of treatment outcomes between nonsurgical and surgical treatment of distal radius fracture in elderly: a systematic review and meta-analysis. Langenbecks Arch Surg 2015;400(7):767–79.
- Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am 2000;25(1):19-28.
- Barton T, Chambers C, Bannister G. A comparison between subjective outcome score and moderate radial shortening following a fractured distal radius in patients of mean age 69 years. J Hand Surg Eur Vol 2007;32(2):165-9.
- Martinez-Mendez D, Lizaur-Utrilla A, de-Juan-Herrero J. Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating. J Hand Surg Eur Vol 2018;43(2):142-7.
- MacDermid JC, Richards RS, Donner A, Bellamy N, Roth JH. Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture. J Hand Surg Am 2000;25(2):330-40.
- Green DP, O’Brien ET. Open reduction of carpal dislocations: indications and operative techniques. J Hand Surg Am 1978;3(3):250–65.
- Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am 1994;19(2):325-40.
- Villar RN, Marsh D, Rushton N, Greatorex RA. Three years after Colles’ fracture. A prospective review. J Bone Joint Surg Br 1987;69(4):635-8.
- Porter M, Stockley I. Fractures of the distal radius. Intermediate and end results in relation to radiologic parameters. Clin Orthop Relat Res 1987;(220):241-52.
- Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am 2006;31(3):359-65.
- Combined Randomised and Observational Study of Surgery for Fractures in the Distal Radius in the Elderly (CROSSFIRE) Study Group, Lawson A, Naylor JM, Buchbinder R, Ivers R, Balogh ZJ, et al. Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial. JAMA Surg 2021;156(3):229-37.
- Hassellund SS, Williksen JH, Laane MM, Pripp A, Rosales CP, Karlsen Ø, et al. Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures. Bone Joint J 2021;103-B(2):247-55.
- Chan YH, Foo TL, Yeo CJ, Chew WY. Comparison between cast immobilization versus volar locking plate fixation of distal radius fractures in active elderly patients, the Asian perspective. Hand Surg 2014;19(1):19-23.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | December 12, 2022 |
| Submission Date | April 11, 2022 |
| Published in Issue | Year 2022Volume: 61 Issue: 4 |
