Skip to main content
SpringerLink
Log in

State of the Art: Behandlungsstrategien bei distaler Radiusfraktur des älteren Patienten

State of the art: Treatment strategies in fractures of the distal radius in elderly patients

  • ÜBERSICHT
  • Published:
Obere Extremität Aims and scope Submit manuscript

Abstract

The treatment of distal radius fractures in elderly patients has been a topic of debate over recent decades. Age-related changes in bony structure may complicate fracture management. Traditional methods including conservative treatment, pins and plaster, external fixation and Kirschner wires are opposed to modern concepts of treatment established in recent years including locking fixed angle plates. However, no consensus about the treatment of distal radius fracture in the elderly based on the patient’s functional demands exists. Elderly patients with low functional demands enjoy subjective outcomes that are good despite the presence of radiological deformity. Patients with higher functional demands profit from internal stabilization with faster recovery. Internal fixation also showed lower rates of complications, especially wound infections.

Zusammenfassung

Die Behandlung distaler Radiusfrakturen bei älteren Patienten stellt nach wie vor eine Herausforderung dar. Altersbedingte Veränderungen der Knochenstruktur erhöhen die Frakturinzidenz nach dem 65. Lebensjahr deutlich und erschweren die Retention und Stabilisierung. Verschiedene Behandlungsstrategien wie konservative Gipsbehandlung, pins and plaster, K-Drahtosteosynthesen und Fixateur externe und interne Stabilisierungen stehen zur Verfügung und können mit Implantation durch Knochenersatzstoffe kombiniert werden. Allerdings herrscht bisher noch Uneinigkeit über die Wahl des geeigneten Verfahrens. Außerdem zeigt sich eine Diskrepanz zwischem radiologischem und funktionellem Ergebnis. Trotz radiologisch sichtbarer Fehlstellung zeigen ältere Patienten mit geringem funktionellen Anspruch ein gutes subjektives Ergebnis. Demgegenüber kann bei Anwendung von Plattenosteosynthesen die Rückkehr zur gewohnten Lebensführung bei Patienten mit höherem funktionellen Anspruch deutlich beschleunigt werden. Insgesamt zeigt sich bei Behandlung durch interner Stabilisierung mit Plattenosteosynthesen auch eine geringere Rate an Komplikationen, die insbesondere bei Behandlung mit dem Fixateur externe zu beobachten sind.

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

Similar content being viewed by others

Literatur

  1. Vogt MT, Cauley JA, Tomaino M, et al.(2002) Distal Radius Fractures in OlderWomen: A 10-Year Follow-Up Study ofDescriptive Characteristics and RiskFactors. The Study of OsteoporoticFractures. J Am Geriatr Soc 50:97–103

    Article  PubMed  Google Scholar 

  2. Cummings SR, Black DM, Rubin SM(1989) Lifetime risks of hip, Colles’, orvertebral fracture and coronary heartdisease among white postmenopausalwomen. Arch Intern Med 149:2445–2448

    Article  CAS  PubMed  Google Scholar 

  3. Singer BR, McLauchlan GJ, RobinsonCM, Christie J (1998) Epidemiology offractures in 15,000 adults: the influenceof age and gender. J Bone Joint Surg Br80:243–248

    Article  CAS  PubMed  Google Scholar 

  4. Hung LK, Wu HT, Leung PC, Qin L(2005) Low BMD is a risk factor for lowenergyColles’ fractures in women beforeand after menopause. Clin OrthopRelat Res 435:219–225

    Article  Google Scholar 

  5. Brenner H, Arndt V (2004) Epidemiologyin aging research. Exp Gerontol 39:679–686

    Article  PubMed  Google Scholar 

  6. Hegeman JH, Oskam J, van der Palen J,Ten Duis HJ, Vierhout PA (2004) Thedistal radial fracture in elderly womenand the bone mineral density of thelumbar spine and hip. J Hand Surg 29B:473–476

    Article  Google Scholar 

  7. Nesbitt KS, Failla JM, Les C (2004) Assessmentof instability factors in adultdistal radius fractures. J Hand Surg 29A:1128–1138

    Article  Google Scholar 

  8. Lafontaine M, Delince P, Hardy D, SimonsM (1989) Instability of fracturesof the lower end of the radius: aproposof a series of 167 cases. Acta OrthopBelg 55:203–216

    CAS  Google Scholar 

  9. Porter M, Stockley I (1987) Fractures ofthe distal radius. Intermediate and endresults in relation to radiologic parameters.Clin Orthop Relat Res 220:241–252

    Google Scholar 

  10. McQueen MM, MacLaren A, Chalmers J(1986) The value of remanipulatingColles’ fractures. J Bone Joint Surg 68B:232–233

    Google Scholar 

  11. Leone J, Bhandari M, Adili A, McKenzieS, Moro JK, Dunlop RB (2004) Predictorsof early and late instability followingconservative treatment of extraarticulardistal radius fractures. ArchOrthop Trauma Surg 124:38–41

    Article  Google Scholar 

  12. Beumer A, McQueen MM (2003) Fracturesof the distal radius in low-demandelderly patients: closed reduction of novalue in 53 of 60 wrists. Acta OrthopScand 74:98–100

    Google Scholar 

  13. Jaremko JL, Lambert RG, Rowe BH,Johnson JA, Majumdar SR (2007) Doradiographic indices of distal radiusfracture reduction predict outcomes inolder adults receiving conservativetreatment? Clin Radiol 62:65–72

    Article  CAS  PubMed  Google Scholar 

  14. Young BT, Rayan GM (2000) Outcomefollowing nonoperative treatment ofdisplaced distal radius fractures in lowdemandpatients older than 60 years. JHand Surg 25A:19–28

    Article  Google Scholar 

  15. Anzarut A, Johnson JA, Rowe BH, LambertRG, Blitz S, Majumdar SR (2004)Radiologic and patient-reported functionaloutcomes in an elderly cohortwith conservatively treated distal radiusfractures. J Hand Surg 29A:1121–1127

    Article  Google Scholar 

  16. Kelly AJ, Warwick D, Crichlow TP, BannisterGC (1997) Is manipulation ofmoderately displaced Colles’ fractureworthwhile? A prospective randomizedtrial. Injury 28:283–287

    Article  CAS  PubMed  Google Scholar 

  17. Azzopardi T, Ehrendorfer S, Coulton T,Abela M (2005) Unstable extra-articularfractures of the distal radius: a prospective,randomised study of immobilisationin a cast versus supplementarypercutaneous pinning. J Bone Joint Surg87B:837–840

    Article  Google Scholar 

  18. Roumen RM, Hesp WL, Bruggink ED(1991) Unstable Colles’ fractures in elderlypatients. A randomised trial ofexternal fixation for redisplacement. JBone Joint Surg 73B:307–311

    Google Scholar 

  19. Hegeman JH, Oskam J, Vierhout PA, TenDuis HJ (2005) External fixation for unstableintra-articular distal radial fracturesin women older than 55 years. Acceptablefunctional end results in themajority of the patients despite significantsecondary displacement. Injury 36:339–344

    Article  CAS  PubMed  Google Scholar 

  20. Dayican A, Unal VS, Ozkurt B, PortakalS, Nuhoglu E, Tumoz MA (2003) Conservativetreatment in intra-articularfractures of the distal radius: a study onthe functional and anatomic outcomein elderly patients. Yonsei Med J 44:836–840

    Article  PubMed  Google Scholar 

  21. Fujii K, Henmi T, Kanematsu Y, MishiroT, Sakai T, Terai T (2002) Fractures ofthe distal end of radius in elderly patients:a comparative study of anatomicaland functional results. J OrthopSurg (Hong Kong) 10:9–15

    Google Scholar 

  22. McQueen M, Caspers J (1988) Collesfracture: does the anatomical result affectthe final function? J Bone Joint Surg70B:649–651

    Google Scholar 

  23. Board T, Kocialkowski A, Andrew G(1999) Does Kapandji wiring help inolder patients? A retrospective comparativereview of displaced intra-articulardistal radial fractures in patientsover 55 years. Injury 30:663–669

    Article  CAS  PubMed  Google Scholar 

  24. Jakob M, Mielke S, Keller H, Metzger U(1999) Results of therapy after primaryconservative management of distal radiusfractures in patients over 65 yearsof age. Handchir Mikrochir Plast Chir31:241–247

    Article  CAS  PubMed  Google Scholar 

  25. Kwasny O, Fuchs M, Hertz H, Quaicoe S(1990) Skeletal transfixation in treatmentof comminuted fractures of thedistal end of the radius in the elderly. JTrauma 30:1278–1284

    CAS  Google Scholar 

  26. Hutchinson DT, Strenz GO, Cautilli RA(1995) Pins and plaster vs external fixationin the treatment of unstable distalradial fractures. A randomized prospectivestudy. J Hand Surg 20B:365–372

    Article  Google Scholar 

  27. Strohm PC, Muller CA, Boll T, Pfister U(2004) Two procedures for Kirschnerwire osteosynthesis of distal radial fractures.A randomized trial. J Bone JointSurg 86A:2621–2628

    Article  Google Scholar 

  28. Ochman S, Frerichmann U, Armsen N,Raschke MJ, Meffert RH (2006) Is use ofthe fixateur externe no longer indicatedfor the treatment of unstable radialfracture in the elderly? Unfallchirurg109:1050–1057

    Article  CAS  PubMed  Google Scholar 

  29. Atroshi I, Brogren E, Larsson GU, KloowJ, Hofer M, Berggren AM (2006) Wristbridgingversus non-bridging externalfixation for displaced distal radiusfractures:a randomized assessor-blindclinical trial of 38 patients followed for1 year. Acta Orthop 77:445–453

    Article  PubMed  Google Scholar 

  30. Fu YC, Chien SH, Huang PJ, Chen SK,Tien YC, Lin GT, Wang GJ (2006) Use ofan external fixation combined with thebuttress-maintain pinning method intreating comminuted distal radius fracturesin osteoporotic patients. J Trauma60:330–333

    Article  PubMed  Google Scholar 

  31. Pritchett JW (1995) External fixation orclosed medullary pinning for unstableColles fractures? J Bone Joint Surg Br77:267–269

    CAS  Google Scholar 

  32. Cannegieter DM, Juttmann JW (1997)Cancellous grafting and external fixationfor unstable Colles’ fractures. JBone Joint Surg 79B:428–432

    Article  Google Scholar 

  33. Kopylov P, Adalberth K, Jonsson K,AspenbergP (2002) Norian SRS versusfunctional treatment in redisplaceddistal radial fractures: a randomizedstudy in 20 patients. J Hand Surg (Br)27:538–541

    Article  CAS  Google Scholar 

  34. Sanchez-Sotelo J, Munuera L, Madero R(2000) Treatment of fractures of thedistal radius with a remodellable bonecement: a prospective, randomisedstudy using Norian SRS. J Bone JointSurg Br 82:856–863

    Article  CAS  Google Scholar 

  35. Linhart W, Briem D, Schmitz ND, PriemelM, Lehmann W, Rueger JM (2003)Treatment of metaphyseal bone defectsafter fractures of the distal radius. Medium-term results using a calciumphosphatecement (BIOBON). Unfallchirurg106:618–624

    Article  CAS  PubMed  Google Scholar 

  36. Huber FX, Hillmeier J, Herzog L,McArthur N, Kock HJ, Meeder PJ (2006)Open reduction and palmar plate-osteosynthesisin combination with a nanocrystallinehydroxyapatite spacer in thetreatment of comminuted fractures ofthe distal radius. J Hand Surg 31B:298–303

    Article  Google Scholar 

  37. Jeyam M, Andrew JG, Muir LT, McGovernA (2002) Controlled trial of distalradial fractures treated with a resorbablebone mineral substitute. JHand Surg 27B:146–149

    Article  Google Scholar 

  38. Orbay JL, Fernandez DL (2004) Volarfixed-angle plate fixation for unstabledistal radius fractures in the elderly patient.J Hand Surg 29A:96–102

    Article  Google Scholar 

  39. Voigt C, Lill H (2006) What advantagesdoes volar plate fixation have over Kwirefixation for distal radius extensionfractures in the elderly? Unfallchirurg109:845–854

    Article  CAS  PubMed  Google Scholar 

  40. Keller M, Steiger R (2006) Open reductionand internal fixation of distal radiusextension fractures in women over60 years of age with the dorsal radiusplate (pi-plate). Handchir MikrochirPlast Chir 38:82–89

    Article  CAS  Google Scholar 

  41. Jubel A, Prokopp A, Andermahr J, OrthB, Rehm K (2004) Functional OutcomeFollowing Fixed-Angle Volar Plating orIntrafocal K-Wire Fixation for ExtraarticularFractures of the Distal Part ofthe Radius. E J Trauma 31:44–50

    Article  Google Scholar 

  42. Schupp A, Tuttlies C, Mohlig T, SiebertHR (2003) Distal radius fractures. 2.4mm locking compression plates. Arethey worth the effort? Chirurg 74:1009–1017

    Article  CAS  PubMed  Google Scholar 

  43. Walz M, Kolbow B, Auerbach F (2004)Do fixed-angle T-plates offer advantagesfor distal radius fractures in elderlypatients? Unfallchirurg 107:664–670

    CAS  PubMed  Google Scholar 

  44. Koeck H, Bandl WD, Chan T (2005) Experiencesand results with the lockedcompression plate for 603 fractures ofthe distal radius. Handchir MikrochirPlast Chir 37:303–308

    Article  Google Scholar 

  45. Dumont C, Fuchs M, Folwaczny EK,Heuermann C, Sturmer KM (2003) Resultsof palmar T-plate osteosynthesisin unstable fractures of the distal radius.Chirurg 74:827–833

    Article  CAS  PubMed  Google Scholar 

  46. Jupiter JB, Ring D, Weitzel PP (2002)Surgical treatment of redisplaced fracturesof the distal radius in patients olderthan 60 years. J Hand Surg 27A:714–723

    Article  Google Scholar 

  47. Washburn RA, McAuley E, Katula J, MihalkoSL, Boileau RA (1999) The physicalactivity scale for the elderly (PASE):evidence for validity. J Clin Epidemiol52:643–651

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

    S. V. Gehrmann, M. Hakimi & J. Windolf

  2. Dept. of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA

    R. A. Kaufmann

Authors
  1. S. V. Gehrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Hakimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Windolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. A. Kaufmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gehrmann, S.V., Hakimi, M., Windolf, J. et al. State of the Art: Behandlungsstrategien bei distaler Radiusfraktur des älteren Patienten. Obere Extremität 3, 154–161 (2008). https://doi.org/10.1007/s11678-008-0096-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11678-008-0096-z

Key words

Schlüsselwörter

Search

Navigation