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Distal Radius Fractures in the Elderly: Predictors of Functional Outcome
Daniel Master, M.D., Nathan Bohnert, M.S., Stephen Lacey, M.D., Kevin Malone, M.D.
University Hospitals Case Medical Center
2010-03-28
Presenter: Daniel Master, M.D.
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Hand
Introduction
The optimal treatment algorithm for elderly patients with distal radius fractures has not been well-defined. The purpose of this study was to determine the relationship between patient functional demands, fracture management, and post-treatment patient rated outcomes in elderly patients with closed, isolated distal radius fractures.
Methods
A prospectively-generated database of patients with musculoskeletal injuries identified 25 elderly (age > 60 years) patients with closed, isolated distal radius fractures.
Pre-injury functioning (as measured by the Physical Activity Scale for the Elderly, PASE, score), fracture characteristics, and fracture management were then analyzed utilizing a stepwise multiple linear regression model to determine any association with the Patient Rated Wrist Evaluation (PRWE) score at latest follow-up.
Results
The mean age at injury was 69 years (range, 60 to 85). Sixteen patients received non-operative management and 9 patients received operative management with a volar locked plating system. The decision for non-operative versus operative management was non-randomized being left at the discretion of the treating surgeon.
The presence of volar comminution at the time of injury was the only factor associated with significantly (p < 0.01) decreased PRWE scores at latest follow-up. Pre-injury PASE scores and the decision for non-operative versus operative management with a volar locked plating system were not significantly associated with PRWE scores in this population.
Conclusion
Volar comminution in elderly patients with closed, isolated distal radius fractures is associated with decreased PRWE scores independent of patient functional demands and non-operative versus operative management with volar locked plating systems.
