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Are Distal Radial Fractures in Elderly Patients Best Managed by Percutaneous Wires or Moulded Cast – a Retrospective Comparative Study?
Robert W. Jordan, MBChB, MRCS; Rahil Naeem; Saqiba Jadoon; Gunaratnam Shyamalan
Trauma & Orthopaedic, Birmingham Heartlands Hospital, Birmingham, United Kingdom

Introduction: Distal radius fractures are common in the elderly population. The management remains controversial with recent publications reporting comparable functional outcomes between percutaneous wires and plate fixation despite worse radiographic measurements after wire fixation. Surgical intervention in elderly patients carries a risk and manipulation with cast treatment alone offers an alternative modality. Previous reports suggest that acceptable results can be expected after cast treatment even if mal-union occurs. This study aims to compare cast treatment with percutaneous wire fixation in terms of radiographic and functional outcomes in elderly patients.

Methods: A retrospective comparative study was performed of all displaced distal radius fractures presenting to our centre between April 2011 and March 2013. Patients over the age of 50 who were treated with either cast or percutaneous wire fixation were included. Displaced fractures were defined according to Sarmiento’s modification of Lidstrom’s scoring system. Patient demographics were recorded and the fracture was graded according to the AO classification. Measurement of radiographic outcome was performed at 10-12 weeks and included radial inclination, radial length and volar/dorsal angulation. Functional outcome was measured at a mean of 19 months (range 12 to 36) using the QuickDASH score. The need for further surgical intervention was recorded.

Results: A total of 161 patients were included in the study; 88 in cast group and 73 in wire group. Patient demographics and fracture type between the groups are demonstrated in Table I. Radiographic outcome was significantly better following percutaneous wire fixation with good or excellent results in 85% of patient compared to 55% in the cast group. However the functional outcomes were not significantly different between the groups. A higher proportion required further surgical intervention following cast treatment; 18.2% versus 5.5%. Despite this, no functional difference was demonstrated between the two groups with either intention to treat or per protocol analysis.

Table I – Demographics of the two study groups

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