Skip to main content

Advertisement

Log in

Distal Radius Fractures in the Elderly: Indications for Operative Management

  • Geriatric Orthopedics (EG Meinberg, Section Editor)
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

Abstract

Distal radius fractures are the most common fracture involving the upper extremity. Despite their frequency, there is a lack of consensus within the orthopedic community regarding indications for operative management of these injuries in the elderly population. An increase in the rate of operative fixation has been cited in the past decade, however, there is no definitive evidence in the literature to support such a trend. Although studies have reported successful functional outcomes with both operative and nonoperative management, the current evidence regarding indications for operative management remains inconclusive due to a lack of large-scale, prospective, randomized trials in the elderly population. Until evidence-based algorithms can be established, treatment decisions must be made based on clinical judgment and risk assessment, while taking into account the functional demands of each patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Court-brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691–7.

    Article  PubMed  Google Scholar 

  2. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg [Am]. 2001;26(5):908–15.

    Article  CAS  Google Scholar 

  3. Baron JA, Karagas M, Barrett J, et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology. 1996;7:612–8.

    Article  PubMed  CAS  Google Scholar 

  4. Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113–25.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Koval KJ, Harrast JJ, Anglen JO, Weinstein JN. Fractures of the distal part of the radius. The evolution of practice over time. Where's the evidence? J Bone Joint Surg Am. 2008;90(9):1855–61.

    Article  PubMed  Google Scholar 

  6. United States Census Bureau. United States Census 2000. http://www.census.gov. Accessed 23 Nov 2013.

  7. Shauver MJ, Yin H, Banerjee M, Chung KC. Current and future national costs to Medicare for the treatment of distal radius fracture in the elderly. J Hand Surg [Am]. 2011;36(8):1282–7. This study reports on the current cost of elderly distal radius fractures to the Medicare system and highlights these fractures as a health-care spending concern by estimating the future financial burden of elderly distal radius fractures on the Medicare system as the frequency of operative fixation increases.

    Article  Google Scholar 

  8. 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.e2. This systematic review evaluates 21 papers on patients with a mean age greater than 60 years and concludes that there is no significant difference in functional outcome between operative and nonoperative management in this population, despite significantly worse radiographic outcomes in nonoperative groups.

    Article  Google Scholar 

  9. Padegimas EM, Osei DA. Evaluation and treatment of osteoporotic distal radius fracture in the elderly patient. Curr Rev Musculoskelet Med. 2013;6(1):41–6.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am. 2009;91:1868–73.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Beharrie AW, Beredjiklian PK, Bozentka DJ. Functional outcomes after open reduction and internal fixation for treatment of displaced distal radius fractures in patients over 60 years of age. J Orthop Trauma. 2004;18:680–6.

    Article  PubMed  Google Scholar 

  12. Mattila VM, Huttunen TT, Sillanpaa P, Niemi S, Pihlajamaki H, Kannus P. Significant change in the surgical treatment of distal radius fractures: a nationwide study between 1998 and 2008 in Finland. J Trauma. 2011;71:939–42. This study highlights the dramatic increase in the rate of open reduction and internal fixation of elderly distal radius fractures from 1998–2008.

    Article  PubMed  Google Scholar 

  13. Fanuele J, Koval KJ, Lurie J, Zhou W, Tosteson A, Ring D. Distal radial fracture treatment: what you get may depend on your age and address. J Bone Joint Surg Am. 2009;91(6):1313–9.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Chung KC, Shauver MJ, Yin H, Kim HM, Baser O, Birkmeyer JD. Variations in the use of internal fixation for distal radial fracture in the United States Medicare population. J Bone Joint Surg Am. 2011;93(23):2154–62.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Wilcke MK, Abbaszadegan H, Adolphson PY. Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year. Acta Orthop. 2011;82(1):76–81. This study shows that operative fixation results in better short-term functional outcomes when compared to nonoperative management, however, this increased rate of recovery is not associated with superior functional outcome at 1 year.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Egol K, Walsh M, Tejwani N, Mclaurin T, Wynn C, Paksima N. Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospective trial. J Bone Joint Surg (Br). 2008;90(9):1214–21.

    Article  CAS  Google Scholar 

  17. AAOS Guideline on the Treatment of Distal Radius Fractures. http://www.aaos.org/research/guidelines/drfsummary. Accessed 1 Dec 2013.

  18. Lichtman DM, Bindra RR, Boyer MI, et al. Treatment of distal radius fractures. J Am Acad Orthop Surg. 2010;18(3):180–9.

    PubMed  Google Scholar 

  19. Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg. 2000;25A:19–28.

    Article  Google Scholar 

  20. Anzarut A, Johnson JA, Rowe BH, Lambert RGW, Blitz S, Majumdar SR. Radiologic and patient- reported functional outcomes in an elderly cohort with conservatively treated fractures. J Hand Surg. 2004;29A:1121–7.

    Article  Google Scholar 

  21. Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radial fractures. J Bone Joint Surg Am. 2006;88(9):1944–51.

    Article  PubMed  CAS  Google Scholar 

  22. Ring D, Jupiter JB. Treatment of osteoporotic distal radius fractures. Osteoporos Int. 2005;16:S80–4.

    Article  PubMed  Google Scholar 

  23. Majumdar SR. Radiologic and patient-reported functional out- comes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg [Am]. 2004;29(6):1121–7.

    Article  Google Scholar 

  24. 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;32:165–9.

    Article  PubMed  CAS  Google Scholar 

  25. McQueen M, Caspers J. Colles fracture: does the anatomical result affect the final function? J Bone Joint Surg (Br). 1988;70:649–51.

    CAS  Google Scholar 

  26. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68:647–59.

    PubMed  CAS  Google Scholar 

  27. McQueen M. Management of distal radial fractures. J R Coll Surg Edinb. 1989;34:161.

    PubMed  CAS  Google Scholar 

  28. 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.

    Article  CAS  Google Scholar 

  29. Arora R, Gabl M, Gschwentner M, et al. A comparative study of clinical and radiologic outcomes of unstable Colles type distal radius fractures in patients older than 70 years: Non- operative treatment versus volar locking plating. J Orthop Trauma. 2009;23(4):237–42.

    Article  PubMed  Google Scholar 

  30. Egol KA, Walsh M, Romo-Cardoso S, et al. Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Joint Surg Am. 2010;92(9):1851–7.

    Article  PubMed  CAS  Google Scholar 

  31. Li S, Chen Y, Lin Z, Feng Z, Zhao J, Su W. A comparison of open reduction and closed reduction in treating distal radius fractures in elderly patients. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010;24(4):438–42.

    PubMed  Google Scholar 

  32. 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.

    Article  Google Scholar 

  33. Roumen RM, Hesp WL, Bruggink ED. Unstable Colles’ fractures in elderly patients. A randomised trial of external fixation for redisplacement. J Bone Joint Surg Br. 1991;73(2):307–11.

    PubMed  CAS  Google Scholar 

  34. Hegeman JH, Oskam J, van der Palen J, et al. Primary external fixation versus plaster immobilization of the intra-articular unstable distal radial fracture in the elderly. Akt Traumatol. 2004;34(2):64–70.

    Article  Google Scholar 

  35. Azzopardi T, Ehrendorfer S, Coulton T, Abela M. Unstable extra-articular fractures of the distal radius: a prospective, randomized study of immobilization in a cast versus supplementary percutaneous pinning. J Bone Joint Surg (Br). 2005;87(6):837–40.

    Article  CAS  Google Scholar 

  36. Wong TC, Chiu Y, Tsang WL, Leung WY, Yam SK, Yeung SH. Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population: a prospective randomised controlled trial. J Hand Surg Eur Vol. 2010;35(3):202–8.

    Article  PubMed  CAS  Google Scholar 

  37. 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. This prospective study is one of the few level I trials investigating operative versus nonoperative treatment of distal radius fractures specifically in the elderly population. The authors concluded that although operative treatment resulted in better radiographic outcomes, anatomic reduction was not associated with any functional advantage at 1 year.

    Article  PubMed  Google Scholar 

  38. Wrist and Radius Injury Surgical Trial (WRIST) Study Group. Reflections 1 year into the 21-Center National Institutes of Health—funded WRIST study: a primer on conducting a multicenter clinical trial. J Hand Surg Am. 2013;38(6):1194–201.

    Google Scholar 

  39. A clinical trial for the surgical treatment of elderly distal radius fractures. The Wrist and Radius Injury Surgical Trial (WRIST). Available at: http://www.mayo.edu/research/clinical-trials/CTS-00103841. Accessed 2 Dec 2013. This trial will provide the level I evidence necessary to develop evidence-based algorithms for choosing operative versus nonoperative treatment in the elderly.

  40. Chung KC, Song JW. A guide to organizing a multicenter clinical trial. Plast Reconstr Surg. 2010;126(2):515–23.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  41. Bartl C, Stengel D, Bruckner T, et al. Open reduction and internal fixation versus casting for highly comminuted and intra-articular fractures of the distal radius (ORCHID): protocol for a randomized clinical multi-center trial. Trials. 2011;12:84. This trial will provide the level I evidence necessary to develop evidence-based algorithms for choosing operative versus nonoperative treatment in the elderly.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Shauver MJ, Clapham PJ, Chung KC. An economic analysis of outcomes and complications of treating distal radius fractures in the elderly. J Hand Surg [Am]. 2011;36(12):1912–8.e1-3. This study cites the results of a cost-utility analysis on the various treatment options of distal radius fractures in the elderly and reports ORIF as a worthwhile alternative to casting.

    Article  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Deirdre Regan and Kenneth Egol declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kenneth Egol.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Regan, D., Egol, K. Distal Radius Fractures in the Elderly: Indications for Operative Management. Curr Geri Rep 3, 109–114 (2014). https://doi.org/10.1007/s13670-014-0081-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13670-014-0081-x

Keywords

Navigation