Effect of patient age on malunion of distal radius fractures subject to operative treatment

Purpose: It has been shown that advancing age is the most important parameter to predict reduction loss of distal radius fractures treated with closed reduction and plaster cast immobilization. Purpose of the present study was to investigate if age influenced the radiological outcome following surgical fixation. Methods: Radiographic outcomes of 200 distal radius fractures following surgical treatment were retrospectively assessed. Outcome was considered poor when fractures had healed with a dorsal tilt greater than 10°, a palmar tilt exceeding 16° or palmar displacement of the fracture, intra-articular steps greater than 2 mm or more than 2 mm radial shortening. Most fractures were treated with percutaneous K-wire fixation (n=139) and palmar plates (n=50). There were 128 women and 64 men. Mean age of the patients was 54 years (range: 16 – 96 yrs). The fracture was caused by a simple fall in 107 wrists and in a high energy trauma in 41 wrists. The majority of fractures were initially dorsally displaced (n=162) and 127 fractures were intra-articular. Results: Thirty-five percent of fractures were malunited. In patients over 65 years of age, malunion was present in 54 % of the cases. Mean age of patients with malunion was 60 and without 51 years. Nineteen patients had dorsal malunion (mean age 68), 17 palmar malunion (mean age 53 years), 16 radiocarpal incongruency with an acceptable palmar tilt (mean age: 51 years) and 17 had radial shortening with an acceptable palmar tilt without intra-articular incongruity (mean age 65). The differences were statistically significant. When wrists treated with K-wires were evaluated separately, mean age of patients with malunion was 62 and without 50 years (P < 0.0001). In fractures stabilized with a palmar plate, mean age of patients without malunion was 52 and with 56 years, this difference was not significant (P= 0.39). Conclusions: In the present study it was found that patients with malunion after surgical treatment were older than those without malunion. The influence of age on malunion was greater for K-wires than for palmar plates with locking screws. However, a reliable comparison between the two treatment methods cannot be made, as more fractures sustained in a high velocity trauma were treated with a palmar plate than with K-wires