Non-Operative Treatment or Volar Locking Plate Fixation for Distal Radius Fractures with Dorsal Displacement in Patients Over 70 Years – Three-Year Follow-Up of a Randomized Controlled Trial

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BMC musculoskeletal disorder. 2022 May 12;23(1):447. doi: 10.1186/s12891-022-05394-7.

ABSTRACT

BACKGROUND: Surgical treatment of displaced distal radius fractures (DRFs) in elderly patients has increased, despite lack of evidence of its superiority over nonsurgical treatment. How the choice of treatment affects these patients after the initial 12-month period remains unknown. This study presents clinical and radiographic follow-up at an average of 3 years after treatment in a randomized clinical trial comparing outcomes in patients aged ≥ 70 years, with a distal radius fracture with dorsal displacement treated either surgically with volar plate locking or non-operatively.

Methods: Between 2009 and 2017, 140 patients aged ≥70 years with dorsally displaced FRD were randomized to receive volar locking plate (VLP) surgery or nonsurgical treatment. On average 3 years after inclusion, participants were invited for additional follow-up. The primary endpoint was the patient’s wrist assessment (PRWE). Secondary outcomes included additional patient-reported outcome measures (PROMs), grip strength, range of motion, complications, and radiologic findings.

RESULTS: Sixty-six patients were available for a 3-year follow-up, 33 in the untreated group and 33 in the VLP group. The average age at the accident was 77 years old. At 3 years, the median PRWE was better (0 points) in the VLP group than in the non-operative treatment group (9 points). p-value: 0.027. No statistically significant differences were found in arm, hand and shoulder (DASH) disabilities, EuroQol 5 (EQ-5D) dimensions or grip strength. The total arc of range of motion was greater in the surgically treated group. No significant difference in osteoarthritis was found. Both groups had regained their grip strength. The complication rate was similar. Results improved from the 1-year follow-up to the 3-year follow-up.

CONCLUSIONS: Volar locking plate surgery resulted in less long-term disability compared to nonoperative treatment for severely displaced distal radius fractures in patients aged ≥70 years. Our results were statistically significant, but in the lower range of clinical significance.

TRIAL REGISTRATION: The study was registered with: NCT02154620 06/03/2014 and NCT01268397 12/30/2010. Ethical approval was obtained from the Ethics Committee in Stockholm, Sweden (2009/37-31/3, 2013/105-31/2, 2014/1041-32, 2017/611-32).

PMID:35549696 | DOI: 10.1186/s12891-022-05394-7

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