The appropriate treatment of distal radius fractures in older, lower demand patients is controversial. Options include cast treatment, percutaneous pinning and various methods of open reduction internal fixation. In this study, radiographic and functional outcomes were assessed in 53 patients over the age of 55. Functional outcomes were measured using range of motion, the DASH, the Patient-Rated Wrist Evaluation, the Modernized Activity Subjective Survey, the Gartland and Werley tool, and an objective hand performance test. These were compared to radiographic angulation, articular step off, radial shortening and preoperative comminution.
Operative treatment was performed in 27 patients (percutaneous pinning (n=4), ORIF (n=20), external fixation (n=3), and closed reduction and immobilization (n=26). Follow-up ranged from only 6 months to 45 months.
Surprisingly, radiographic displacement and comminution had no effect on subjective or objective outcome assessments (flexion-extension, radioulnar deviation, supination-pronation, pinch strength, and outcome scoring listed above). Surgical treatment was not found to be an independent predictor of functional outcome but did prevent dorsal angulation and shortening.
Currently, there are numerous treatment options for distal radius fractures designed to restore anatomic parameters. This study could not show, in an older patient population, that anatomic reduction results in improved function. However, the follow-up was short and a greater number of patients might be needed to reveal statistically significant differences. In addition, treatment methods that allow independence and a more rapid functional outcome may be an important factor in this patient population.