Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years - a three year follow-up of a randomized controlled trial

Hanna Südow, Sara Severin, Maria Wilcke, Jenny Saving, Olof Sköldenberg, Cecilia Mellstrand Navarro, Hanna Südow, Sara Severin, Maria Wilcke, Jenny Saving, Olof Sköldenberg, Cecilia Mellstrand Navarro

Abstract

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

Methods: Between 2009 and 2017, 140 patients aged ≥70 years with dorsally displaced DRF were randomized to surgery with volar locking plate (VLP) or non-operative treatment. At an average of 3 years after inclusion the participants were invited to an additional follow-up. The primary outcome was Patient Rated Wrist Evaluation (PRWE). Secondary outcomes included additional Patient Reported Outcome Measures (PROM), grip strength, range of motion, complications and radiological results.

Results: Sixty six patients were available for a 3 year follow-up, 33 in the non-operatively treated group and 33 in the VLP-group. The mean age at injury was 77 years. 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 difference was found in Disabilities of the Arm, Hand, and Shoulder (DASH), EuroQol 5 Dimensions (EQ-5D) or grip strength. Total arc of range of motion was larger in the operatively treated group. No significant difference in osteoarthritis was found. Both groups had regained grip strength. The complication rate was similar. Outcomes improved from the 1 year to the 3 year follow-up.

Conclusions: Surgery with volar locking plate gave less long-term disability compared to non-operative treatment for severely displaced distal radius fractures in patients aged ≥70 years. Our findings were statistically significant but in the lower range of clinical importance.

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

Keywords: Aged; Distal radius fracture; Fracture fixation; Geriatric fracture; Non-operative treatment; Quality of life; Volar locking plate.

Conflict of interest statement

Non to declare.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT flow diagram of an RCT comparing treatments for dorsally displaced distal radius fractures
Fig. 2
Fig. 2
Histogram of PRWE (Patient Rated Wrist Evaluation) 3 years after a distal radius fracture in patients ≥70 years in a randomized to non-operative treatment or surgery with volar locking plate
Fig. 3
Fig. 3
Sixty-six patients over the age of 70 sustained a dorsally displaced distal radius and were allocated to surgery with a volar plate or non-operative treatment. The diagram illustrates the change in Patient Rated Wrist Evaluation (PRWE) for each individual between the 1 year (blue square) and 3 year follow-up (red circle). The patients are displayed according to worst to best wrist-function (left to right) at 1 year
Fig. 4
Fig. 4
Sixty-six patients over the age of 70 sustained a dorsally displaced distal radius and were allocated to surgery with a volar plate or non-operative treatment. The diagram illustrates the change in Corrected grip strength as a percent of the strength of the non-injured hand for each individual between the 1 year (blue square) and 3 year follow-up (red circle). The patients are displayed according to worst to best corrected grip strength (left to right) at 1 year

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