Distal Radius Fractures in the Elderly: Factors Affecting Treatment Decisions

Tal Kalimand MD¹, Roni Wollstein MD²

1. Department of Orthopedic Surgery, University of Alabama, Heersink School of Medicine, Birmingham, AL, USA.

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PUBLISHED: 30 November 2023

CITATION: Kalimian, T., Wollstein, R., 2024. Distal Radius Fractures in the Elderly: Factors Affecting Treatment Decisions. Medical Research Archives, [online] 12(11).
https://doi.org/10.18103/mra.v12i11.6145

COPYRIGHT © 2024 European Society of Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

DOI https://doi.org/10.18103/mra.v12i11.6145

ISSN 2375-1924

Abstract

Distal radius fractures are common and are becoming more so with population aging. 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, our limited ability to account for many of these factors, decision-making remains controversial and differs by geographical area as well as from individual to individual. We aim to present the current literature regarding the factors affecting treatment decisions for distal radius fractures in the elderly population.

Keywords

distal radius fractures, elderly, treatment decisions, factors affecting treatment

Introduction

The World Health Organization predicts that by the year 2050, the global life expectancy will reach 70 years and older will double. As life expectancy increases, so will the elderly population expecting to preserve function into older age. Still, with advancing age and increasing osteoporosis, comes a higher risk of fragility fractures, with fractures of the distal radius being among the most common.

Lower extremity fractures contribute to significant morbidity, causing higher deterioration and reducing life expectancy; injury to the upper extremity, particularly the distal radius, can lead to significant impairment in psychological adjustment and quality of life, and that these patients are more susceptible to the development of psychological disorders.

Another study evaluated resident involvement in distal radius fracture surgery and found that though it is associated with longer operative time, this involvement does not affect rates of episode-of-care adverse events.

A recent meta-analysis by Zhu et al. found slightly better results with operative treatment of distal radius fractures looking at grip strength and motion as well as DASH scores. Martinez-Mendez et al. in a randomized controlled trial looked specifically at intra-articular fractures in 97 elderly patients and demonstrated that placing surgical better in pain and DASH scores, than closed reduction and cast treatment. They concluded that open reduction and internal fixation with a volar locking plate leads to better outcomes.

Factors Affecting Treatment Decisions

While there is an unambiguous account, as related to the specific characteristics of the fracture, there remains considerable debate regarding the role of patient characteristics, including age, comorbidities, and functional status.

Fracture type, energy, and function, is another factor to consider when determining treatment options. The American Academy of Orthopaedic Surgeons (AAOS) guidelines regarding treatment of distal radius fractures suggest that the “appropriate” treatment is based on the fracture type and the patient’s functional status.

Another aspect of decision-making in distal radius fractures pertains to local societal values and culture. These include cost and access to treatment and are reflected in study results. These differences are demonstrated in disparate treatment guidelines between different countries.

A recent study evaluated the use of translated and culturally adapted patient-centered outcome measures, and found that patients and their families expressed a desire for more information regarding treatment options and expected outcomes.

Summary

Our perspective continues to evolve, and we need to continue to adapt our treatment approaches. Fractures in the elderly population become more prevalent and it is important to appreciate the evidence (or lack thereof) supporting treatment recommendations for elderly patients.

Because there are so many variables that impact outcomes, and there are variables that are difficult to account for many of them, a review of the literature cannot provide clear guidelines for each category of distal radius fractures in the elderly patient. Therefore, there is a need to treat our patients and this ability increases as we develop our understanding of the factors influencing treatment decisions.

Conclusions

Distal radius fractures in the elderly population require careful decision-making, involving patients, families, and healthcare providers, in order to create personalized care plans that respect the patient’s values and lifestyle.

References

1. Nellans KW, Kowalski C, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2010;26(2):213-224.

2. Parajuli R, Sharma R, Kayastha SR, Thapa SR, Shrestha R. Assessing Spectrum of Distal Radius Fractures in Elderly: Perspective on Tertiary Care Hospital of Nepal. Kathmandu Univ Med J (KUMJ). Jan-Mar 2023;21(1):64-68.

3. Toan B, Ali N, Karachiwala W, et al. Risk of Subsequent Hip Fractures across Varying Treatment Patterns in Acute Vertebral Compression Fractures. J Clin Med 2024; 13(16): 1010-1013.

4. Pollock RD, Carter S, Velloso CP, et al. The impact of psychological factors on recovery after distal radius fracture. J Physiol 2018; 596(15): 2953-2959.

5. Kyllikeski J, Tziavrangos E, Weinberg DS, et al. Distal Radius Fractures: AAOS Appropriate Use Criteria. J Hand Surg. 2021; 46(1): 140-147.

6. Matzen JL, Lutsky KF, Maloney M, Beredjiklian PK. Adherence to the AAOS upper-extremity clinical practice guidelines. Orthopedics. Nov 2021; 34(11): 1407-11. doi:10.3928/01477447-20210312-021.

7. Kyllikeski J, Tziavrangos E, Weinberg DS, et al. Distal Radius Fractures: AAOS Appropriate Use Criteria. J Hand Surg. 2021; 46(1): 140-147.

8. Sager M, Joshi S, Kothari A, Thordardottir A, Wernberg M, Moller M. Distal radius fractures in the elderly: a systematic review of the literature. BMC Geriatr. 2022; 22(1): 110. doi:10.1186/s12877-022-02711-4.

9. Makhlouf M, Larin A, Tzeng H, et al. Reoperation Rate of Patients With Distal Radius Fractures: A Comparison of Surgical Techniques. J Hand Surg. 2021; 46(4): 317-324. doi:10.1016/j.jhsa.2020.10.007.

10. Chung KC, He H, Kim Y, Kim HW, Salomon J. Association Between Functional Outcomes and Radiographic Reduction Following Distal Radius Fractures. J Hand Surg Asian Pac Vol. 2019; 24(2): 258-263. doi:10.1142/S2424835520150030.

11. Wong J, Wong A, Lee J, et al. The impact of patient factors on recovery after distal radius fracture. J Hand Surg. 2020; 45(1): 119-124. doi:10.1016/j.jhsa.2019.09.013.