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Kim, Seo, Jeon, Lee, and Son: Comparative Study of Outcomes between Operative and Non-Operative Treatment of Unstable Distal Radius Fracture in the Elderly Patients
Original Article

J Korean Soc Surg Hand 2015;20(2):43-50.

Published online: 8 June 2015

DOI: https://doi.org/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

Jong Min Kim, Hyun Je Seo, Young Dae Jeon, Hyung Min Lee, Jung Hwan Son

Department of Orthopedic Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea

Correspondence to: Jung Hwan Son Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 602-702, Korea TEL: +82-51-990-6467 FAX: +82-51-243-0181 E-mail: junghson@dreamwiz.com

Received 19 March 201517 June 2015       Accepted 20 June 2015

Copyright © 2015 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 15.5°, average VT of 14.1°, average RS of 5.3 mm, The patients who received operative treatments showed average volar tilt of 3.9°, average VT of 18.2°, 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.

Keywords: Unstable distal radius fracture, Operative treatment, Non-operative treatment

References

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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.
jkssh-20-43f1.tif
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.
jkssh-20-43f2.tif
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.
jkssh-20-43f3.tif
Table 1.
Summary of dermographic data
Characteristic Non-operative groups (n=45) Operative groups (n=69)
Age (yr) 73.1 (65-89) 70.8 (65-84)
Sex, n (%)
  Female 36 (80) 50 (72)
  Male 9 (20) 19 (28)
Follow-up period (mon) 10.1 (6-20) 11.4 (6-22)
Cause of fracture, n (%)
  Slip down 39 (86) 59 (85)
  Fall down 3 (7) 7 (10)
  Trauma 3 (7) 3 (5)

Values are presented as mean±æstandard deviation.

Table 2.
Complications of distal radius fracture for both
Value Non-operative groups (n=45) Operative groups (n=69)
Malunion 21 (47) 11 (16)
Complex regional pain syndrome 3 (7) 7 (10)
Carpal Tunnel syndrome 1 (2) 5 (7)
Pin-site infection - 4 (6)
Superficial radial nerve injury - 1 (1.5)
Flexor tendon injury - 1 (1.5)

Values are presented as number (%).

Table 3.
Radiologic measurements for both groups
Value Non-operative groups (n=45) Operative groups (n=69) p-value
Dorsal tilt
  Preoperative -17.7±4.7 -19.2±5.0 0.42
  Postoperative -18.2±4.0 4.2±3.3 0.11
  Last follow-up -15.5±4.2 3.9±3.0 0.228
Radial inclination
  Preoperative 16±6.3 13.6±6.7 0.767
  Postoperative 15.6±5.4 19.3±4.8 0.202
  Last follow-up 14.1±5.5 18.2±5.1 0.249
Radial shortening
  Preoperative -6.2±2.4 -6.4±2.6 0.34
  Postoperative -6.4±2.0 -1.2±1.6 0.011
  Last follow-up -5.3±1.8 -1.1±1.5 0.001

Values are presented as mean±standard deviation.

Table 4.
Functional outcomes at final follow-up for both groups
Value Non-operative groups (n=45) Operative groups (n=69) p-value
Range of motion
  Flexion 51.4±9.2 54.7±10.5 0.156
  Extension 44±6.7 46.9±7.2 0.009
  Supination 71.8±8.8 70.8±9.0 0.562
  Pronation 76.1±10.1 77.2±10.8 0.355
  Radial deviation 17.4±3.8 18.6±5.4 0.25
  Ulnar deviation 20.9±5.5 23±5.0 0.46
Disabilities of arm, shoulder and hand 19.5±11.5 17.4±9.4 0.203
Modified Mayo wrist score 81.9±6.1 83.2±5.7 0.444

Values are presented as mean±standard deviation.

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