Effectiveness of Non-Operative Treatment vs. Operative Treatment of Unstable Distal Radius Fractures in the Elderly

Abstract Background There has been an ongoing debate on how to treat patients over 65 with unstable distal radius fractures. The purpose of this systematic analysis is to review the literature and determine if nonoperative care in the form of casting vs. operative care can be as effective in this specific population. Methods An exhaustive search of available medical literature using the following databases: MEDLINE-Ovid, CINAHL, Web of Science and Clinical Key using search terms fracture fixation, radius fracture, aged, non-operative and unstable was undertaken. Outcomes of interest included Disabilities of the Arm, Shoulder, and Hand (DASH) scores and Patient related Wrist Evaluation (PRWE) to determine functionality, wrist range-of-motion (ROM), pain, grip strength, and radiographic findings. The purpose was to determine outcomes of these various factors comparing the nonoperative vs. operative approaches in those patients over 65 years old. GRADE was utilized in assessing the quality of evidence. Results One prospective randomized study6 and two retrospective studies7,4 were analyzed. The prospective study demonstrated that there was no difference in functionality of the fractured wrist between the operative and conservatively managed groups at one year after sustaining unstable distal radius fracture. Both of the retrospective studies also concluded that at one year after the initial fracture there was no difference in functional status between the groups. Complications occurred less frequently in the conservatively managed patients across all three studies 6,7,4 whereas grip strength and radiographic findings were improved in the operative group. Conclusion At one year follow up examination of the non-operative group vs. operative group in the treatment of unstable distal radius fractures, grip strength and radiographic findings were better in the operative group. Functionality based on DASH scores, ROM and pain in those over age 65 showed no significant differences. Therefore, since functionality is similar with either intervention, in patients where surgical risks are high, the non-operative approach can be considered. Given the growing elderly population, the social-economic impact of this injury and the morbidities associated with putting an elderly patient through surgery it is a reasonable decision to choose non-operative management in those over 65 with unstable distal radius fractures. Of course, patient lifestyle, activity level and daily routine would play a significant role in the decision to have surgery vs. elect conservative management. It is assuring to note that no matter what the decision, conservative management does not change functional outcome of the fracture at one-year post injury