Distal radius fracture management in elderly patients a literature review

Distal radius fracture management in elderly patients a literature review

Apr 01,  · Distal radius fracture management in elderly patients remains without consensus regarding the appropriate treatment or anticipated outcome. Multiple treatment methods, such as pins and plaster, external fixation, K-wires, bone cement and open reduction, and internal fixation with plates have been compared with higher rates of infection being observed with external fixation and K-wire Cited by: 4 Distal radius fractures are common in elderly patients, and the incidence continues to increase as the population ages. The goal of treatment is to provide a painless extremity with good function. In surgical decision making, special attention should be given to the Cited by: 67 One case series showed that 89% of all elderly patients with distal radius fractures and conservative therapy have good to excellent outcomes [2]. Furthermore, surgery is associated with longer

Distal radius fractures in the elderly population

Try out PMC Labs and tell us what you think. Learn More. Distal radius fractures account for nearly 1 of every 5 fractures in individuals aged 65 or older. Moreover, increased susceptibility to vertebral and hip fractures has been documented in patients a year after suffering a distal radius fracture, distal radius fracture management in elderly patients a literature review.

Although women are more susceptible distal radius fracture management in elderly patients a literature review hip fractures, men experience a higher mortality rate in the 7 years following a distal radius fracture. Traditional approaches to distal radius fractures have included both surgical and nonsurgical treatments, with predominant complaints involving weakness, stiffness, and pain. Nonsurgical approaches include immobilization with or without reduction, whereas surgical treatments include dorsal spanning bridge plates, percutaneous pinning, external fixation, and volar plate fixation.

Historically, closed reduction and percutaneous pinning have been the most popular approaches. However, volar plate fixation is quickly becoming a popular option as it minimizes tendon irritation, reduces immobilization time, and decreases risk of complication.

The goal of treatment is to restore mobility, reduce pain, and improve functional outcomes following rehabilitation. The aim of this review is to summarize the most common treatments and importance of early referral to hand therapy to improve functional outcomes.

Distal radius fractures have a high incidence among the aging population and may potentially result in poor functional outcome and impairment. Age-related fragility is a consequence of accelerated bone breakdown and increases the risk of developing osteopenia and osteoporosis. This number may increase in the future due to the combination of a longer lifespan and low bone density.

Traditionally, distal radius fractures in those over the age of 65 have been treated both nonsurgically and surgically. Nonoperative nonsurgical options include immobilization with or without reduction, where the fractured bone is reduced without opening the skin and then subsequently immobilized to avoid potential displacement of fracture while healing. Although bone heals naturally, closed reduction can minimize the risk of infection, which is a rare but possible complication using surgical treatment.

Surgically, volar locking plate fixation is a procedure that is becoming increasingly popular due to newer plate designs and is used in more complex fracture cases that include severe fragmentation or significant articular displacement.

The use of volar plates achieves the benefits of stable internal fixation and minimizing tendon irritation, while avoiding the shortcomings of other traditional approaches. These shortcomings include longer immobilization times and higher rates of complication. Distraction or dorsal spanning bridging plates is rapidly becoming a viable treatment method due to the benefit of permitting fixation without relying on bone quality.

Moreover, it allows for early weight bearing. Interestingly, outcomes following both surgical and nonsurgical treatment approaches after a year have shown no significant difference. Despite apparent radiological differences, functional outcomes following both nonsurgical and surgical procedures were similar after a year of treatment.

Percutaneous pinning is the second most common treatment option, representing 8. Finally, internal fixation represents 3. With the exception of closed reduction, the trend shows decreasing use in techniques with increasing age. Patients with good bone quality, limited fracture displacement, and minimal involvement of joint surface are commonly treated with closed reduction.

Rehabilitation can be beneficial and critical for improving functional outcomes following the treatment of distal radius fractures for some patients. The rehabilitative process is often complicated by challenges associated with prolonged recovery times, discomfort, pain, and decreased mobility. Despite these challenges, the clinical outcome following distal radius fractures is acceptable, the majority of patients showing no or minimal disability based on the Disability of Arm, Hand, and Shoulder DASH scores.

Common complaints following distal radius fracture include weakness, pain, and stiffness. The focus of distal radius fracture rehabilitation is to manage pain and allow the patient to regain motion, strength, and most importantly, function. With appropriate rehabilitation, typical outcomes for wrist flexion, extension, pronation, and supination at 1-year follow-up are 59°, 63°, 80°, and 81°, respectively.

Although wrist range of motion ROM is a commonly reported functional outcome measure, patient-reported outcomes are more closely related to the preservation of digit mobilization. During the period of splinting, ROM exercises should be initiated in the digits through both passive assisted and active exercises. Early therapy programs focus on increasing ROM of the digits, wrist, and forearm while the wrist is immobilized. A key goal is to educate patients in early fine motor and dexterity activities.

Time frames when patients begin mobilization vary based on the treatment. Advances in the distal radius fracture management in elderly patients a literature review of volar plating for the distal radius fracture management in elderly patients a literature review of distal radius fractures allow for early ROM 7 to 10 days postoperatively in stable functions, whereas mobilization following closed treatment in a cast typically begins after immobilization lasting up to 6 weeks.

Valdes 10 conducted a retrospective study that examined the mean number of therapy visits required to regain motion between an early ROM group treated with open reduction and internal fixation and a late ROM group treated with closed reduction and casting following distal radius fractures. The mean number of therapy visits in the early ROM group was 6. The final phase focuses on return to normal activity through strengthening exercises and simulated activities. At this phase of the rehabilitation program, patients are discharged to a home program.

Therapists typically assume the role of a coach and assist patients in adhering to their programs in order to reduce their perceived level of impairment. Outcome measurements assess impairment and overall function. Following a distal radius fracture, patient outcome is assessed using several variables including radiographic outcomes, ROM, grip strength, pinch strength, distal radius fracture management in elderly patients a literature review, and patient-rated functional outcome measures.

A successful clinical outcome after distal radius fracture has traditionally been based on objective measures such as improved radiographic distal radius fracture management in elderly patients a literature review, wrist ROM, and grip strength. However, patients are more interested in their ability to complete everyday functional activities. Recently, focus has shifted to the psychosocial effects of injury, leading to the development of patient-rated outcome measurement systems.

Two commonly employed patient-rated functional outcome measures are the DASH and Michigan Hand Questionnaire MHQ scales. The DASH is a validated outcome measure that consists of a question survey, with a lower score indicating better function. Studies have investigated whether scores on patient-rated functional outcome measures are correlated with radiographic and objective findings in the setting of distal radius fractures.

Shauver et al 17 examined functional outcome variables related to the MHQ score. Their study found that the MHQ score was significantly affected by grip strength but not by ROM measurements. In their retrospective study, Wilcke et al 15 examined the correlation between radiographic findings, objective measurements, and DASH scores.

Their findings indicate that a better score on the DASH correlated with final radiographic findings and objective variables of both grip and wrist extension.

However, Kumar et al 20 reported that among an elderly cohort of patients older than 60 years, both DASH and MHQ scores were rated satisfactorily, despite radiographic findings of dorsal angulation.

Although wrist ROM is one of the most commonly reported outcome measures after a distal radius fracture, several studies have failed to establish a correlation between this parameter and patient-rated outcomes. The current changes in health care coupled with the increasingly active lifestyles of the elderly patient warrant a closer assessment of treatment options for distal radius fractures.

Clinical decision-making pertaining to elderly patients is different from younger patients and must account for factors such as bone quality, joint involvement, occupation, activity level, current or previous injuries, and fracture type. Treatment with internal stabilization such as volar plating allows for early active motion and reduces the potential for fracture displacement during lengthy periods of casting following closed reduction.

However, other options are available and can be utilized based on the type of fracture the patient suffered among other factors. Early involvement in a therapy program can be beneficial to some patients and may ultimately reduce the number of therapy visits required to regain functional strength and motion.

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Journal List Geriatr Orthop Surg Rehabil v, distal radius fracture management in elderly patients a literature review. Geriatr Orthop Surg Rehabil. Published online Sep doi: PMCID: PMC Tochukwu C. IkpezeMS, 1 Heather C. SmithMS, 2 Daniel J. LeeMD, 3 and John C. ElfarMD 4. Ikpeze 1 University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Find articles by Tochukwu C. Heather C. Smith 2 Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Find articles by Heather C.

Daniel J. Lee 3 Department of Orthopaedics, Washington University in St Louis, St Louis, MO, USA Find articles by Daniel J. John C. Elfar 4 Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Find articles by John C. Author information Copyright and License information Disclaimer. Corresponding author. Elfar, University of Rochester, Elmwood BoxRochester, NYUSA.

Email: moc. liamg raflenepo. Copyright © The Author s This article has been cited by other articles in PMC. Abstract Distal radius fractures account for nearly 1 of every 5 fractures in individuals aged 65 or older.

Keywords: adult reconstructive surgery, fragility fractures, geriatric medicine, geriatric trauma, osteoporosis, upper extremity surgery. Introduction Distal radius fractures have a high incidence among the aging population and may potentially result in poor functional outcome and impairment.

Rehabilitative Goals Following Distal Radius Fracture Treatment The focus of distal radius fracture rehabilitation is to manage pain and allow the patient to regain motion, strength, and most importantly, function.

Outcome Measures Distal radius fracture management in elderly patients a literature review Distal Radius Fracture Treatment Outcome measurements assess impairment and overall function. Conclusion The current changes in health care coupled with the increasingly active lifestyles of the elderly patient warrant a closer assessment of treatment options for distal radius fractures.

Older Patient Preferences After a Distal Radius Fracture —Video Discussion by Steven Henry, MD

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Evidence-Based Review of Distal Radius Fractures

Mar 01,  · Increasing numbers of distal radius fractures in elderly patients with greater functional demands led us to review the existing literature on its management. This effort included randomized clinical trials, prospective cohort studies, and retrospective reviews that included at least 10 patients with a minimum mean age of 65 years and that were published between and Cited by: Distal Radius Fracture Management In Elderly Patients A Literature Review all necessary elements for providing college kids with effective academic Distal Radius Fracture Management In Elderly Patients A Literature Review support. Yes, applying for our help means making a win-win deal!/10() One case series showed that 89% of all elderly patients with distal radius fractures and conservative therapy have good to excellent outcomes [2]. Furthermore, surgery is associated with longer