Comparison of treatment outcomes between nonsurgical and surgical treatment of distal radius fracture in elderly: a systematic review and meta-analysis
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The best treatment of distal radius fractures (DRFs) in the elderly is uncertain. The purpose of this meta-analysis was to compare the outcomes of surgical and nonsurgical management of DRFs in persons 65 years of age or older.
Medline, Cochrane, EMBASE, and Google Scholar databases were searched until April 27, 2015 using the following search terms: distal radius fracture, conservative treatment, nonoperative treatment, nonsurgical treatment, surgical treatment, operative, elderly, and older. The primary outcome measure was DASH score, and secondary outcomes were functional and radiological assessments. The standard difference in post-treatment means was calculated for the outcomes to compare the two groups.
Of 59 articles identified, eight studies with a total of 440 patients in the surgical groups and 449 in the control groups were included in the analysis. No significant differences in DASH score, VAS pain score, grip strength, wrist extension, pronation, or supination, and ulnar deviation were noted between the groups. The nonsurgical group had significantly greater wrist flexion, radial deviation, and ulnar variance and less radial inclination than the surgical group.
Surgical and nonsurgical methods produce similar results in the treatment of DRFS in the elderly, and minor objective functional differences did not result an impact on subjective function outcome and quality of life.
KeywordsDistal radius fracture Elderly Internal fixation Meta-analysis Nonsurgical Open reduction
Conflicts of interest
Jihui Ju: study design, literature research, clinical studies, data acquisition, statistical analysis, manuscript preparation
Guangzhe Jin: literature research, clinical studies, data acquisition
Guanxing Li: literature research, clinical studies, data acquisition
Haiyang Hu: literature research, clinical studies, data acquisition
Ruixing Hou: guarantor of integrity of the entire study, study design, manuscript review
- 3.Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M (2009) 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 23:237–242CrossRefPubMedGoogle Scholar
- 4.Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M (2011) 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 93:2146–2153PubMedGoogle Scholar
- 12.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:W65–94CrossRefPubMedGoogle Scholar
- 13.Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, Carpenter J, Rücker G, Harbord RM, Schmid CH, Tetzlaff J, Deeks JJ, Peters J, Macaskill P, Schwarzer G, Duval S, Altman DG, Moher D, Higgins JP (2011) Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomized controlled trials. BMJ 343:d4002. doi: 10.1136/bmj.d4002 CrossRefPubMedGoogle Scholar
- 14.Bartl C, Stengel D, Bruckner T, Gebhard F; ORCHID Study Group (2014) The treatment of displaced intra-articular distal radius fractures in elderly patients. Dtsch Arztebl Int 111:779–787Google Scholar