Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures

Anzarut, Alexander; Johnson, Jeffrey; Rowe, Brian H.; Lambert, Robert G.; Blitz, Sandra; Majumdar, Sumit R.

doi:10.1016/j.jhsa.2004.07.002

Cited by 177 publications

(168 citation statements)

References 27 publications

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“…All patients came from one tertiary care academic institution, and the results of the patient population and treatment preferences of this institution may not be generalizable to other patients in this age group. However, the demographics of our patient population (ie, age and gender) are similar to those of comparable studies [3,19,49]. There were various followups for patients in our study cohort (6-45 months); we recognize 6 months' minimum followup is perhaps not enough time to unmask major effects of certain potential complications of distal radius fracture, including posttraumatic arthritis, intercarpal instability, and pseudosubluxation, which may occur as a result of long-standing major malalignment.…”

Section: Discussionsupporting

confidence: 56%

“…There were various followups for patients in our study cohort (6-45 months); we recognize 6 months' minimum followup is perhaps not enough time to unmask major effects of certain potential complications of distal radius fracture, including posttraumatic arthritis, intercarpal instability, and pseudosubluxation, which may occur as a result of long-standing major malalignment. However, similar studies use a comparable followup in terms of minimum or average followup [3,12,19,22,29,32]. Moreover, we found no correlations between length of followup and functional outcome.…”

Section: Discussionmentioning

confidence: 43%

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Distal Radius Fractures in Older Patients: Is Anatomic Reduction Necessary?

Synn

Makhni

et al. 2008

Clin Orthop Relat Res

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The relationship between radiographic and functional outcomes in older patients with distal radius fractures is controversial. We explored this relationship by assessing the influence of radiographic displacement and fracture comminution on the functional outcomes of these fractures. We also asked whether operative intervention and demographic factors (age, gender, duration of followup) influenced outcome. We examined 53 patients older than 55 years with distal radius fractures with various functional assessments: range of motion (ROM) and strength measurements, three subjective surveys (Disabilities of the Arm, Shoulder, and Hand; Patient-rated Wrist Evaluation; Modernized Activity Subjective Survey of 2007), a Gartland and Werley score, and an objective, standardized hand performance test (Jebsen-Taylor). We measured angulation, articular gap/stepoff, and radial shortening on final radiographs and fracture comminution of preoperative radiographs. We observed no effect of radiographic displacement on subjective or objective outcome assessments, including standardized hand performance timed testing. Surgically treated fractures were less likely to display residual dorsal angulation and radial shortening, but surgical intervention did not independently predict functional outcome. Fracture comminution, patient gender, and months of followup similarly had no effect on outcome. We found no relationship between anatomic reduction as evidenced by radiographic outcomes and subjective or objective functional outcomes in this older patient cohort.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 43%

Distal Radius Fractures in Older Patients: Is Anatomic Reduction Necessary?

Synn

Makhni

et al. 2008

Clin Orthop Relat Res

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“…The degree of dorsal angulation at the time of complete healing could be predicted for 60% of the individuals of a population on the basis of the known dorsal dislocation after reduction. The DA has great significance for the function of the wrist, as it influences the degree of flexion and results in an incongruence in the distal radioulnar joint (DRUJ) [1,11,23,25]. It would thus be desirable to be able to estimate the degree of dislocation at a time when it is still possible to influence it.…”

Section: Discussionmentioning

confidence: 99%

“…This involves the initial closed reduction of the fracture and fixation with a forearm cast for 5-6 weeks [6]. In many cases, predominantly good functional healing results are reported for the cast treatment [1,2,5,24].…”

Section: Introductionmentioning

confidence: 99%

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Can the displacement of a conservatively treated distal radius fracture be predicted at the beginning of treatment?

Einsiedel¹,

Freund

Sander

et al. 2008

International Orthopaedics (SICOT)

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The aim of this study was to investigate whether the final displacement of conservatively treated distal radius fractures can be predicted after primary reduction. We analysed the radiographic documents of 311 patients with a conservatively treated distal radius fracture at the time of injury, after reduction and after bony consolidation. We measured the dorsal angulation (DA), the radial angle (RA) and the radial shortening (RS) at each time point. The parameters were analysed separately for metaphyseally "stable" (A2, C1) and "unstable" (A3, C2, C3) fractures, according to the AO classification system. Spearman's rank correlations and regression functions were determined for the analysis. The highest correlations were found for the DA between the time points 'reduction' and 'complete healing' (r=0.75) and for the RA between the time points

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Assessment of Anatomic Restoration of Distal Radius Fractures Among Older Adults

et al. 2020

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IMPORTANCE The value of precise anatomic restoration for distal radius fractures (DRFs) in older adults has been debated for many decades, with conflicting results in the literature. In light of the growing population of adults aged 60 years and older, both fracture incidence and associated treatment costs are expected to increase. OBJECTIVE To determine the association between radiographic measures of reduction and patient outcomes after DRF in older patients. DESIGN, SETTING, AND PARTICIPANTS Data were collected from the Wrist and Radius Injury Surgical Trial (WRIST), a multicenter randomized clinical trial of DRF treatments for adults aged 60 years and older (enrollment from April 10, 2012, to December 31, 2016, with a 2-year follow-up). Data analysis was performed from January 3, 2019, to August 19, 2019. WRIST participants who completed 12-month assessments were included in the study. According to the biomechanical principle of alignment, 2-phase multivariable regression models were adopted to assess the association between radiographic measures of reduction and functional and patient-reported outcomes 12 months following treatment. INTERVENTIONS Participants were randomized to receive volar locking plate, percutaneous pinning, or external fixation. Those who opted for nonoperative treatment received casts. MAIN OUTCOMES AND MEASURES Hand grip strength, wrist arc of motion, radial deviation, ulnar deviation, the Michigan Hand Outcomes Questionnaire (MHQ) total score, MHQ function score, and MHQ activities of daily living score were measured at 12 months following treatment. RESULTS Data from 166 WRIST participants (144 [86.7%] women; mean [SD] age, 70.9 [8.9] years) found that only 2 of the 84 correlation coefficients calculated were statistically significant. For patients aged 70 years or older, every degree increase in radial inclination away from normal (22°) grip strength in the injured hand was 1.1 kg weaker than the uninjured hand (95% CI, 0.38-1.76; P = .004) and each millimeter increase toward normal (0 mm) in ulnar variance was associated with a 10.4-point improvement in MHQ ADL score (95% CI, −16.84 to −3.86; P = .003). However, neither of these radiographic parameters appeared to be associated with MHQ total or function scores. CONCLUSIONS AND RELEVANCE The study results suggest that precise restoration of wrist anatomy is not associated with better patient outcomes for older adults with DRF 12 months following treatment. Surgeons can consider this evidence to improve quality of care by prioritizing patient preferences and efficient use of resources over achieving exact realignment. (continued) Key Points Question What is the association between radiographic measures of reduction and patient outcomes 12 months after distal radius fractures treatment for adults aged 60 years or older? Findings This secondary analysis of a multicenter randomized clinical trial on distal radius fractures treatment options included 166 patients who completed 12-month assessments. Radiographic parameters were not assoc...

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Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures

Cited by 177 publications

References 27 publications

Distal Radius Fractures in Older Patients: Is Anatomic Reduction Necessary?

Distal Radius Fractures in Older Patients: Is Anatomic Reduction Necessary?

Can the displacement of a conservatively treated distal radius fracture be predicted at the beginning of treatment?

Assessment of Anatomic Restoration of Distal Radius Fractures Among Older Adults

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