Skip to main content

Advertisement

SpringerLink
Log in

Are the Clinical Results of Locking Plate Fixation for Distal Radius Fractures Inferior in Patients over 80 Years of Age? A Multicentre (TRON Group) Study

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Introduction

With the aging of the population, the proportion of distal radius fracture patients who are > 80 years of age is increasing. In this study, we compared the postoperative clinical and radiographic outcomes between super-elderly patients (age: ≥ 80 years) and middle-elderly (age: 65–79 years) who were treated with volar locking plate (VLP) fixation for distal radius fractures.

Patients and Methods

Patients of > 65 years of age with distal radius fractures treated by VLP fixation between 2015 and 2019, and who were followed for at least 6 months after surgery were included in our database (named TRON). Patients with open fractures, multiple-trauma, or who received fixation with implants other than a VLP were excluded. We evaluated postoperative complications, Mayo wrist score (MWS), and radiographic outcomes.

Results

We identified 589 patients in this study; 452 were 65–79 years of age (Group A) and 137 were ≥ 80 years of age (Group B). After propensity score matching, we evaluated 309 patients in Group A and 103 patients in Group B. The mean follow-up period was 10.7 ± 4.6 months. Twenty-eight patients (9.1%) in Group A and 5 patients in Group B (4.9%) experienced post-operative complications (non-significant: p = 0.212). The postoperative MWS at 1, 3, and 6 months, respectively, was 65.4 ± 11.7, 75.2 ± 11.0, and 79.6 ± 10.5 in Group A and 67.1 ± 9.61, 75.7 ± 10.7, and 80.6 ± 9.7 in Group B (non-significant: p = 0.418, 0.893, 0.452, respectively). The differences in volar tilt, radial inclination, ulnar variance between the postoperative and last follow-up radiographs did not differ between the two groups to a statistically significant extent (p = 0.053, 0.437, 0.529, respectively).

Conclusion

Our study showed that the clinical and radiographic outcomes of distal radius fractures treated with VLP in super-elderly patients were comparable to those in middle-elderly patients.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

The datasets during and/or analyzed during thecurrent study available from the corresponding author on reasonable request.

References

  1. No author listed (2021). United Nations, Department of Economic and Social Affairs, Population Division. https://population.un.org/wpp/ Accessed: 2021 Sep 29.

  2. Rundgren, J., Bojan, A., Mellstrand Navarro, C., & Enocson, A. (2020). Epidemiology, classification, treatment and mortality of distal radius fractures in adults: An observational study of 23,394 fractures from the national Swedish fracture register. BMC Musculoskeletal Disorders, 21, 88.

    Article  Google Scholar 

  3. Azad, A., Kang, H. P., Alluri, R. K., et al. (2019). Epidemiological and treatment trends of distal radius fractures across multiple age groups. J Wrist Surg., 8, 305–311.

    Article  Google Scholar 

  4. Health and Welfare Bureau for the Elderly. Long-Term Care Insurance System of Japan (2021). https://www.mhlw.go.jp/english/policy/care-welfare/care-welfare-elderly/dl/ltcisj_e.pdf (Accessed: 29 Sep 2021).

  5. Sørensen, T. J., Ohrt-Nissen, S., Ardensø, K. V., Laier, G. H., & Mallet, S. K. (2020). Early mobilization after volar locking plate osteosynthesis of distal radial fractures in older patients–A randomized controlled trial. J Hand Surg Am., 45, 1047-1054.e1.

    Article  Google Scholar 

  6. Xue, S., Kemal, O., Lu, M., et al. (2020). Age at attainment of peak bone mineral density and its associated factors: The National Health and Nutrition Examination Survey 2005–2014. Bone, 131, 115163.

    Article  Google Scholar 

  7. Piuzzi, N. S., Zaidenberg, E. E., Duarte, M. P., et al. (2017). Volar plate fixation in patients older than 70 years with AO type C distal radial fractures: Clinical and radiologic outcomes. J Wrist Surg., 6, 194–200.

    Article  Google Scholar 

  8. Meinberg, E. G., Agel, J., Roberts, C. S., Karam, M. D., & Kellam, J. F. (2018). Fracture and Dislocation Classification Compendium-2018. Journal of Orthopaedic Trauma, 32(Suppl 1), S1-170.

    Article  Google Scholar 

  9. Sasser, S. M., Hunt, R. C., Faul, M., et al. (2012). Guidelines for field triage of injured patients: Recommendations of the National Expert Panel on Field Triage, 2011. MMWR - Recommendations and Reports, 61, 1–20.

    Google Scholar 

  10. Cooney, W. P., Bussey, R., Dobyns, J. H., & Linscheid, R. L. (1987). Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clinical Orthopaedics and Related Research, 214, 136–147.

    Article  Google Scholar 

  11. Huskisson, E. C. (1974). Measurement of pain. Lancet, 2, 1127–1131.

    Article  CAS  Google Scholar 

  12. Urits, I., Shen, A. H., Jones, M. R., Viswanath, O., & Kaye, A. D. (2018). Complex regional pain syndrome, current concepts and treatment options. Current Pain and Headache Reports, 22, 10.

    Article  Google Scholar 

  13. Horan, T. C., Gaynes, R. P., Martone, W. J., Jarvis, W. R., & Emori, T. G. (1992). CDC definitions of nosocomial surgical site infections, 1992: A modification of CDC definitions of surgical wound infections. American Journal of Infection Control, 20, 271–274.

    Article  CAS  Google Scholar 

  14. Carbonell-Escobar, R., Vaquero-Picado, A., Barco, R., & Antuña, S. (2020). Neurologic complications after surgical management of complex elbow trauma requiring radial head replacement. Journal of Shoulder and Elbow Surgery, 29, 1282–1288.

    Article  Google Scholar 

  15. Walenkamp, M. M., Aydin, S., Mulders, M. A., Goslings, J. C., & Schep, N. W. (2016). Predictors of unstable distal radius fractures: a systematic review and meta-analysis. J Hand Surg Eur, 41, 501–515.

    Article  CAS  Google Scholar 

  16. Zenke, Y., Furukawa, K., Furukawa, H., et al. (2019). Radiographic measurements as a predictor of correction loss in conservative treatment of Colles’ fracture. Journal of UOEH, 41, 139–144.

    Article  Google Scholar 

  17. Kanda, Y. (2013). Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplantation, 48(3), 452–458.

    Article  CAS  Google Scholar 

  18. Sokol, S. C., Amanatullah, D. F., Curtiss, S., & Szabo, R. M. (2011). Biomechanical properties of volar hybrid and locked plate fixation in distal radius fractures. J Hand Surg Am., 36, 591–597.

    Article  Google Scholar 

  19. Turner, H. C., Yate, R. M., Giddins, G. E., & Miles, A. W. (2004). A method for measuring vertical forces applied to the upper limb during sit-to-stand. Proceedings of the Institution of Mechanical Engineers. Part H, 218, 461–465.

    Article  CAS  Google Scholar 

  20. Anglin, C., & Wyss, U. P. (2000). Arm motion and load analysis of sit-to-stand, stand-to-sit, cane walking and lifting. Clinical Biomechanics (Bristol, Avon), 15, 441–448.

    Article  CAS  Google Scholar 

  21. Zeckey, C., Späth, A., Kieslich, S., et al. (2020). Early mobilization versus splinting after surgical management of distal radius fractures. Deutsches Ärzteblatt International, 117, 445–451.

    Google Scholar 

  22. Ali Fazal, M., Denis Mitchell, C., & Ashwood, N. (2020). Volar locking plate: Age related outcomes and complications. J Clin Orthop Trauma., 11, 642–645.

    Article  Google Scholar 

  23. Bartl, C., Stengel, D., Bruckner, T., & Gebhard, F. (2014). The treatment of displaced intra-articular distal radius fractures in elderly patients. Dtsch Ärzteblatt Int, 111, 779–787.

    Google Scholar 

  24. Saving, J., SeverinWahlgren, S., Olsson, K., et al. (2019). Nonoperative treatment compared with volar locking plate fixation for dorsally displaced distal radial fractures in the elderly: A randomized controlled trial. The Journal of Bone and Joint Surgery, 101, 961–969.

    Article  Google Scholar 

  25. Arora, R., Lutz, M., Deml, C., et al. (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 Surg, 93, 2146–2153.

    Article  Google Scholar 

  26. Aslan, A., Atay, T., & Aydoğan, N. H. (2020). Risk factors for mortality and survival rates in elderly patients undergoing hemiarthroplasty for hip fracture. Acta Orthopaedica et Traumatologica Turcica, 54, 138–143.

    Article  Google Scholar 

  27. Rundgren, J., Enocson, A., Mellstrand Navarro, C., et al. (2018). Responsiveness of EQ-5D in Patients With a Distal Radius Fracture. Hand (NY)., 13, 572–580.

    Article  Google Scholar 

  28. Amorosa, L. F., Vitale, M. A., Brown, S., et al. (2011). A functional outcomes survey of elderly patients who sustained distal radius fractures. Hand (NY)., 6(3), 260–267.

    Article  Google Scholar 

Download references

Acknowledgements

We thank both the participating hospitals for their contribution of data to this study and the members of the trauma research group (TRON). The TRON Group: Dr. Tokumi Kanemura, Dr. Masahiro Hanabayashi, Dr. Tsunenobu Ichikawa, Dr. Shoichi Shinoda, Dr. Katsuhiro Taguchi, Dr. Yoshiharu Oka, Dr. Hiroyuki Matsubara, Dr. Yuji Matsubara, Dr. Kenichi Yamauchi, Dr. Eiji Kozawa, Dr. Toshiki Iwase and Dr. Hidenori Inoue collection. Special thanks go to Yuma Saito, Yusuke Mori, Yotaro Yamada, Kentaro Komaki, Yasushi Hiramatsu, Yutaro Ono, Yui Matsura, Koichiro Makihara, Ken Mizuno, and Reina Kaneko for encouraging our work.

Funding

There is no supporting funding.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Saki Sakurai, Yasuhiko Takegami, Yutaro Kuwahara, Ryutaro Shibata & Shiro Imagama

  2. Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Katsuhiro Tokutake

  3. Department of Orthopaedic Sugery, Nagoya Ekisaikai Hospital, 4-66 Matunen-cho, Nakagawa-ku, Nagoya, 454-8502, Japan

    Hideyuki Ota & Hiroaki Kumagai

Authors
  1. Saki Sakurai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuhiko Takegami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katsuhiro Tokutake
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yutaro Kuwahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryutaro Shibata
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hideyuki Ota
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroaki Kumagai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shiro Imagama
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SS Data collection and assessment, Study design, Writing the paper. YT Manuscript preparation, Study and Conception design. KT Manuscript preparation, Study design. YK Data collection and assessment, Manuscript preparation. RS Data collection, Manuscript preparation. HO Manuscript preparation. HK Manuscript preparation, SI Conception design, Guarantor.

Corresponding author

Correspondence to Yasuhiko Takegami.

Ethics declarations

Conflict of Interest

All authors have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ref no. 2020–564) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The patients gave their informed consent, after being informed that they had been registered, the purpose of the registration, and the procedure to remove themselves from the registry.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sakurai, S., Takegami, Y., Tokutake, K. et al. Are the Clinical Results of Locking Plate Fixation for Distal Radius Fractures Inferior in Patients over 80 Years of Age? A Multicentre (TRON Group) Study. JOIO 57, 117–123 (2023). https://doi.org/10.1007/s43465-022-00788-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-022-00788-0

Keywords

Search

Navigation