Distal Radius Fractures in the Elderly: Factors Affecting Treatment Decisions
Main Article Content
Abstract
Fractures of the distal radius are common and are becoming more so with population ageing. The choice of treatment depends on the specific characteristics of the fracture and the patient’s functional level. Due to a large number of variables contributing to the outcomes of treatment, and our limited ability to account for many of these factors, decision-making remains controversial and differs by geographical area as well as functional and other considerations. We aim to present the current literature regarding some of the elements affecting treatment decisions for distal radius fractures in the ageing population. By better identifying and evaluating patient-specific factors (including occupation, function, social support system etc.) the indications for treatment and ultimate outcomes can improve.
Keywords:
Distal radius fractures, Elderly patients, Fracture treatment decisions, Patient-specific factors, Functional level in fracture treatment, Ageing population and bone fractures, Treatment outcomes in distal radius fractures, Orthopedic decision-making
Article Details
How to Cite
KALIMIAN, Tal; WOLLSTEIN, Ronit.
Distal Radius Fractures in the Elderly: Factors Affecting Treatment Decisions.
Medical Research Archives, [S.l.], v. 12, n. 11, dec. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6145>. Date accessed: 12 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i11.6145.
Section
Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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4. Pollock RD, Carter S, Velloso CP, et al. An investigation into the relationship between age and physiological function in highly active older adults. J Physiol. Feb 1 2015;593(3):657-80; discussion 680. doi:10.1113/jphysiol.2014.282863
5. Kamal RN, Shapiro LM. Practical Application of the 2020 Distal Radius Fracture AAOS/ASSH Clinical Practice Guideline: A Clinical Case. J Am Acad Orthop Surg. May 1 2022;30(9):e714-e720. doi:10.5435/JAAOS-D-21-01194
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8. Arvidsson L, Landgren M, Harding AK, Abramo A, Tagil M. Patients Aged 80 or More With Distal Radius Fractures Have a Lower One-Year Mortality Rate Than Age- and Gender-Matched Controls: A Register-Based Study. Geriatr Orthop Surg Rehabil. 2024;15:21514593241252583. doi:10.117 7/21514593241252583
9. Sagerfors M, Jakobsson H, Thordardottir A, Wretenberg P, Moller M. Distal radius fractures in the superelderly: an observational study of 8486 cases from the Swedish fracture register. BMC Geriatr. Feb 19 2022;22(1):140. doi:10.1186/s128 77-022-02825-x
10. Lizaur-Utrilla A, Martinez-Mendez D, Vizcaya-Moreno MF, Lopez-Prats FA. Volar plate for intra-articular distal radius fracture. A prospective comparative study between elderly and young patients. Orthop Traumatol Surg Res. Apr 2020; 106(2):319-323. doi:10.1016/j.otsr.2019.12.008
11. Zhang YX, Li C, Wang SW, Zhang ML, Zhang HW. Volar plate fixation vs. non-operative management for distal radius fractures in older adults: a meta-analysis. Eur Rev Med Pharmacol Sci. Jun 2021;25(11):3955-3966. doi:10.26355/ eurrev_202106_26036
12. Zhu C, Wang X, Liu M, et al. Non-surgical vs. surgical treatment of distal radius fractures: a meta-analysis of randomized controlled trials. BMC Surg. Jul 10 2024;24(1):205. doi:10.1186/s12893-024-02485-1
13. Martinez-Mendez D, Lizaur-Utrilla A, de-Juan-Herrero J. Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating. J Hand Surg Eur Vol. Feb 2018;43(2):142-147. doi:10.1177/1753193417 727139
14. Asmara A, Karna MB, Meregawa PF, Deslivia MF. Outcomes of the Management of Distal Radius Fractures in the Last 5 Years: A Meta-analysis of Randomized Controlled Trials. Rev Bras Ortop (Sao Paulo). Dec 2022;57(6):899-910. doi:10.1055/s-0042-1754379
15. MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma. Nov-Dec 1998;12(8):577-86. doi:10.1097/00005131-199811000-00009
16. Westphal T, Piatek S, Schubert S, Schuschke T, Winckler S. [Reliability and validity of the upper limb DASH questionnaire in patients with distal radius fractures]. Z Orthop Ihre Grenzgeb. Jul-Aug 2002;140(4):447-51. Reliabilitat und Validitat des Fragebogens "Upper-Limb-DASH" bei Patienten mit distalen Radiusfrakturen. doi:10.1055/s-2002-33396
17. Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am. Jul 1998;23(4):575-87. doi:10.1016/S0363-5023(98 )80042-7
18. Matzon JL, Lutsky KF, Maloney M, Beredjiklian PK. Adherence to the AAOS upper-extremity clinical practice guidelines. Orthopedics. Nov 2013;36(11) :e1407-11. doi:10.3928/01477447-20131021-22
19. Kyriakedes JC, Tsai EY, Weinberg DS, et al. Distal Radius Fractures: AAOS Appropriate Use Criteria Versus Actual Management at a Level I Trauma Center. Hand (N Y). Mar 2018;13(2):209-214. doi:10.1177/1558944717691133
20. Esakki S, MacDermid J, Vajravelu S. Linking of the American Academy of Orthopaedic Surgeons Distal Radius Fracture Clinical Practice Guidelines to the International Classification of Functioning, Disability, and Health; International Classification of Diseases; and ICF Core Sets for Hand Conditions. Hand (N Y). Sep 2016;11(3):314-321. doi:10.1177/1558944715627305
21. Rosado EG, Olivella G, Natal-Albelo EJ, et al. Practice Variation Among Hispanic American Orthopedic Surgeons in the Management of Geriatric Distal Radius Fracture. Geriatr Orthop Surg Rehabil. 2020;11:2151459320969378. doi:10. 1177/2151459320969378
22. Kart H, Akca E. Do Patients With Dominant-side Distal Radius Fractures Have Greater Psychological Distress Than Those With Nondominant-side Fractures? Clin Orthop Relat Res. Aug 29 2024;doi:10.1097/CORR.0000000000003244
23. Zhang D, Earp BE, Blazar P, Dyer GSM. What Is the Effect of Resident Involvement on Short-Term Outcomes after Distal Radius Fracture Surgery? J Hand Surg Asian Pac Vol. Jun 2023;28 (3):307-314. doi:10.1142/S2424835523500364
24. Liu K, Grigor EJM, Antflek D, Ho G, Baltzer HL, Paul R. Time to surgical management of distal radius fractures: effects on health care utilization and functional outcomes. Can J Surg. Jul-Aug 2024;67(4):E286-E294. doi:10.1503/cjs.010223
25. Mulakaluri A, Julian KR, Fernandez A, Kamal RN, Shapiro LM. Are Clinical Practice Guidelines Representative of Patients With Distal Radius Fractures? A Review of Patient Demographics and Patient-Reported Outcome Measures Used to Inform Guidelines. J Hand Surg Am. Jul 2024;49(7) :649-655. doi:10.1016/j.jhsa.2024.03.015
26. Mahmoud Y, Chung J, Pirzada W, Ilyas AM. Understanding Changing Demographic and Treatment Trends of Distal Radius Fractures: A TriNetX Database Contemporary Analysis of 32,912 Patients. J Hand Surg Glob Online. Jul 2024;6(4):477-483. doi:10.1016/j.jhsg.2024.01.005
27. Lemos J, Xiao M, Castro Appiani LM, Katz P, Kamal RN, Shapiro LM. Are Patient-Reported Outcome Measures for Distal Radius Fractures Validated for Spanish and Culture? A Systematic Review. J Hand Surg Am. Jul 2023;48(7):673-682. doi:10.1016/j.jhsa.2023.03.017
28. Sudow H, Severin S, Wilcke M, Saving J, Skoldenberg O, Navarro CM. Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years - a three year follow-up of a randomized controlled trial. BMC Musculoskelet Disord. May 12 2022;23(1):447. doi:10.1186/s12891-022-05394-7
29. Tutuncu MN, Demiroglu M. Frykman Type 7-8 Distal Radius Fractures in Elderly Patients: Conservative Treatment vs Volar Plating. Cureus. Jun 2024;16(6):e63035. doi:10.7759/cureus.63035
30. Allison R, 2nd, Assadzandi S, Adelman M. Frailty: Evaluation and Management. Am Fam Physician. Feb 15 2021;103(4):219-226.
31. Holeman TA, Peacock J, Beckstrom JL, Brooke BS. Patient-Surgeon Agreement in Assessment of Frailty, Physical Function, & Social Activity. J Surg Res. Dec 2020;256:368-373. doi:10.1016/j.jss.2020.06.059
32. Momtaz D, Ghali A, Ahmad F, et al. Effective Risk Assessment for Distal Radius Fractures: A Rigorous Multivariable Regression Analysis, Using a Novel 8-Item Modified Frailty Index. J Wrist Surg. Apr 2024;13(2):120-126. doi:10.1055/s-0043-1764203
33. Kodama N, Takemura Y, Ueba H, Imai S, Matsusue Y. Acceptable parameters for alignment of distal radius fracture with conservative treatment in elderly patients. J Orthop Sci. Mar 2014;19(2): 292-297. doi:10.1007/s00776-013-0514-y
34. Kitidumrongsook P, Luangjarmekorn P, Kuptniratsaikul V, Teeragananan T, Chaitantipongse S. Measurement of Radiological Parameters of Distal Radius Fracture Using the Ulnar Axis Compared with the Radial Axis. J Hand Surg Asian Pac Vol. Apr 2024;29(2):140-147. doi:10.1142/S24 24835524500164
35. Boszotta H, Helperstorfer W, Sauer G. [Indications for surgery in distal radius fractures]. Unfallchirurg. Aug 1991;94(8):417-23. Zur Operationsindikation bei der distalen Radiusfraktur.
36. Wollstein R, Allon R, Zvi Y, Katz A, Werech S, Palmon O. Association between Functional Outcomes and Radiographic Reduction Following Surgery for Distal Radius Fractures. J Hand Surg Asian Pac Vol. Sep 2019;24(3):258-263. doi:10.11 42/S2424835519500310
37. Chung KC, Cho HE, Kim Y, Kim HM, Shauver MJ, Group W. Assessment of Anatomic Restoration of Distal Radius Fractures Among Older Adults: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. Jan 3 2020;3(1):e1919433. doi:10.1001/jamanetworkopen.2019.19433
2. Parajuli B, Sharma R, Kayastha SR, Thapa J, Shrestha R, Shrestha D. Assessing Spectrum of Fractures in Elderly; Perspective on Tertiary Care Hospital of Nepal. Kathmandu Univ Med J (KUMJ). Jan-Mar 2023;21(81):64-68.
3. Ton A, Bell JA, Karakash WJ, et al. Risk of Subsequent Hip Fractures across Varying Treatment Patterns for Index Vertebral Compression Fractures. J Clin Med. Aug 14 2024 ;13(16)doi:10.3390/jcm13164781
4. Pollock RD, Carter S, Velloso CP, et al. An investigation into the relationship between age and physiological function in highly active older adults. J Physiol. Feb 1 2015;593(3):657-80; discussion 680. doi:10.1113/jphysiol.2014.282863
5. Kamal RN, Shapiro LM. Practical Application of the 2020 Distal Radius Fracture AAOS/ASSH Clinical Practice Guideline: A Clinical Case. J Am Acad Orthop Surg. May 1 2022;30(9):e714-e720. doi:10.5435/JAAOS-D-21-01194
6. Shapiro LM, Kamal RN, Management of Distal Radius Fractures Work G, et al. Distal Radius Fracture Clinical Practice Guidelines-Updates and Clinical Implications. J Hand Surg Am. Sep 2021; 46(9):807-811. doi:10.1016/j.jhsa.2021.07.014
7. Gutierrez-Espinoza H, Araya-Quintanilla F, Cuyul-Vasquez I, et al. Effectiveness and Safety of Different Treatment Modalities for Patients Older Than 60 Years with Distal Radius Fracture: A Network Meta-Analysis of Clinical Trials. Int J Environ Res Public Health. Feb 19 2023;20(4) doi:10.3390/ijerph20043697
8. Arvidsson L, Landgren M, Harding AK, Abramo A, Tagil M. Patients Aged 80 or More With Distal Radius Fractures Have a Lower One-Year Mortality Rate Than Age- and Gender-Matched Controls: A Register-Based Study. Geriatr Orthop Surg Rehabil. 2024;15:21514593241252583. doi:10.117 7/21514593241252583
9. Sagerfors M, Jakobsson H, Thordardottir A, Wretenberg P, Moller M. Distal radius fractures in the superelderly: an observational study of 8486 cases from the Swedish fracture register. BMC Geriatr. Feb 19 2022;22(1):140. doi:10.1186/s128 77-022-02825-x
10. Lizaur-Utrilla A, Martinez-Mendez D, Vizcaya-Moreno MF, Lopez-Prats FA. Volar plate for intra-articular distal radius fracture. A prospective comparative study between elderly and young patients. Orthop Traumatol Surg Res. Apr 2020; 106(2):319-323. doi:10.1016/j.otsr.2019.12.008
11. Zhang YX, Li C, Wang SW, Zhang ML, Zhang HW. Volar plate fixation vs. non-operative management for distal radius fractures in older adults: a meta-analysis. Eur Rev Med Pharmacol Sci. Jun 2021;25(11):3955-3966. doi:10.26355/ eurrev_202106_26036
12. Zhu C, Wang X, Liu M, et al. Non-surgical vs. surgical treatment of distal radius fractures: a meta-analysis of randomized controlled trials. BMC Surg. Jul 10 2024;24(1):205. doi:10.1186/s12893-024-02485-1
13. Martinez-Mendez D, Lizaur-Utrilla A, de-Juan-Herrero J. Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating. J Hand Surg Eur Vol. Feb 2018;43(2):142-147. doi:10.1177/1753193417 727139
14. Asmara A, Karna MB, Meregawa PF, Deslivia MF. Outcomes of the Management of Distal Radius Fractures in the Last 5 Years: A Meta-analysis of Randomized Controlled Trials. Rev Bras Ortop (Sao Paulo). Dec 2022;57(6):899-910. doi:10.1055/s-0042-1754379
15. MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma. Nov-Dec 1998;12(8):577-86. doi:10.1097/00005131-199811000-00009
16. Westphal T, Piatek S, Schubert S, Schuschke T, Winckler S. [Reliability and validity of the upper limb DASH questionnaire in patients with distal radius fractures]. Z Orthop Ihre Grenzgeb. Jul-Aug 2002;140(4):447-51. Reliabilitat und Validitat des Fragebogens "Upper-Limb-DASH" bei Patienten mit distalen Radiusfrakturen. doi:10.1055/s-2002-33396
17. Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am. Jul 1998;23(4):575-87. doi:10.1016/S0363-5023(98 )80042-7
18. Matzon JL, Lutsky KF, Maloney M, Beredjiklian PK. Adherence to the AAOS upper-extremity clinical practice guidelines. Orthopedics. Nov 2013;36(11) :e1407-11. doi:10.3928/01477447-20131021-22
19. Kyriakedes JC, Tsai EY, Weinberg DS, et al. Distal Radius Fractures: AAOS Appropriate Use Criteria Versus Actual Management at a Level I Trauma Center. Hand (N Y). Mar 2018;13(2):209-214. doi:10.1177/1558944717691133
20. Esakki S, MacDermid J, Vajravelu S. Linking of the American Academy of Orthopaedic Surgeons Distal Radius Fracture Clinical Practice Guidelines to the International Classification of Functioning, Disability, and Health; International Classification of Diseases; and ICF Core Sets for Hand Conditions. Hand (N Y). Sep 2016;11(3):314-321. doi:10.1177/1558944715627305
21. Rosado EG, Olivella G, Natal-Albelo EJ, et al. Practice Variation Among Hispanic American Orthopedic Surgeons in the Management of Geriatric Distal Radius Fracture. Geriatr Orthop Surg Rehabil. 2020;11:2151459320969378. doi:10. 1177/2151459320969378
22. Kart H, Akca E. Do Patients With Dominant-side Distal Radius Fractures Have Greater Psychological Distress Than Those With Nondominant-side Fractures? Clin Orthop Relat Res. Aug 29 2024;doi:10.1097/CORR.0000000000003244
23. Zhang D, Earp BE, Blazar P, Dyer GSM. What Is the Effect of Resident Involvement on Short-Term Outcomes after Distal Radius Fracture Surgery? J Hand Surg Asian Pac Vol. Jun 2023;28 (3):307-314. doi:10.1142/S2424835523500364
24. Liu K, Grigor EJM, Antflek D, Ho G, Baltzer HL, Paul R. Time to surgical management of distal radius fractures: effects on health care utilization and functional outcomes. Can J Surg. Jul-Aug 2024;67(4):E286-E294. doi:10.1503/cjs.010223
25. Mulakaluri A, Julian KR, Fernandez A, Kamal RN, Shapiro LM. Are Clinical Practice Guidelines Representative of Patients With Distal Radius Fractures? A Review of Patient Demographics and Patient-Reported Outcome Measures Used to Inform Guidelines. J Hand Surg Am. Jul 2024;49(7) :649-655. doi:10.1016/j.jhsa.2024.03.015
26. Mahmoud Y, Chung J, Pirzada W, Ilyas AM. Understanding Changing Demographic and Treatment Trends of Distal Radius Fractures: A TriNetX Database Contemporary Analysis of 32,912 Patients. J Hand Surg Glob Online. Jul 2024;6(4):477-483. doi:10.1016/j.jhsg.2024.01.005
27. Lemos J, Xiao M, Castro Appiani LM, Katz P, Kamal RN, Shapiro LM. Are Patient-Reported Outcome Measures for Distal Radius Fractures Validated for Spanish and Culture? A Systematic Review. J Hand Surg Am. Jul 2023;48(7):673-682. doi:10.1016/j.jhsa.2023.03.017
28. Sudow H, Severin S, Wilcke M, Saving J, Skoldenberg O, Navarro CM. Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years - a three year follow-up of a randomized controlled trial. BMC Musculoskelet Disord. May 12 2022;23(1):447. doi:10.1186/s12891-022-05394-7
29. Tutuncu MN, Demiroglu M. Frykman Type 7-8 Distal Radius Fractures in Elderly Patients: Conservative Treatment vs Volar Plating. Cureus. Jun 2024;16(6):e63035. doi:10.7759/cureus.63035
30. Allison R, 2nd, Assadzandi S, Adelman M. Frailty: Evaluation and Management. Am Fam Physician. Feb 15 2021;103(4):219-226.
31. Holeman TA, Peacock J, Beckstrom JL, Brooke BS. Patient-Surgeon Agreement in Assessment of Frailty, Physical Function, & Social Activity. J Surg Res. Dec 2020;256:368-373. doi:10.1016/j.jss.2020.06.059
32. Momtaz D, Ghali A, Ahmad F, et al. Effective Risk Assessment for Distal Radius Fractures: A Rigorous Multivariable Regression Analysis, Using a Novel 8-Item Modified Frailty Index. J Wrist Surg. Apr 2024;13(2):120-126. doi:10.1055/s-0043-1764203
33. Kodama N, Takemura Y, Ueba H, Imai S, Matsusue Y. Acceptable parameters for alignment of distal radius fracture with conservative treatment in elderly patients. J Orthop Sci. Mar 2014;19(2): 292-297. doi:10.1007/s00776-013-0514-y
34. Kitidumrongsook P, Luangjarmekorn P, Kuptniratsaikul V, Teeragananan T, Chaitantipongse S. Measurement of Radiological Parameters of Distal Radius Fracture Using the Ulnar Axis Compared with the Radial Axis. J Hand Surg Asian Pac Vol. Apr 2024;29(2):140-147. doi:10.1142/S24 24835524500164
35. Boszotta H, Helperstorfer W, Sauer G. [Indications for surgery in distal radius fractures]. Unfallchirurg. Aug 1991;94(8):417-23. Zur Operationsindikation bei der distalen Radiusfraktur.
36. Wollstein R, Allon R, Zvi Y, Katz A, Werech S, Palmon O. Association between Functional Outcomes and Radiographic Reduction Following Surgery for Distal Radius Fractures. J Hand Surg Asian Pac Vol. Sep 2019;24(3):258-263. doi:10.11 42/S2424835519500310
37. Chung KC, Cho HE, Kim Y, Kim HM, Shauver MJ, Group W. Assessment of Anatomic Restoration of Distal Radius Fractures Among Older Adults: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. Jan 3 2020;3(1):e1919433. doi:10.1001/jamanetworkopen.2019.19433