|
Back to 2017 Scientific Program ePosters
Distal Radius Fracture Volar Plating in the Elderly
Aparajit Naram, MD; Jonathan Miller, BA; BaiJing Qin, MD; Douglas M. Rothkopf, MD
University of Massachusetts Medical School, Worcester, MA
Background: In the treatment of distal radius fractures, current evidence suggests that long-term outcomes may be equivalent regardless of modality. Patients over the age of 65 present a unique challenge for the clinician. While many of these patients have low demand as retirees, they may benefit greatly from early mobilization and return to function for activities of daily living. We present our experience using the volar bearing plate in patients age 65 and older.
Materials and Methods: We conducted a retrospective chart review on all patients age 65 and older that underwent unilateral open reduction internal fixation of distal radius fractures using a volar bearing plate from January 2014 until April 2016. Patients with bilateral injuries or multiple major injuries to the same extremity were excluded. We collected patient demographic data, injury data (mechanism and fracture pattern according to AO classification), operative data (tourniquet time, type of anesthesia and plate size), and post-operative outcomes (radiographs and range of motion measurements).
Results: We identified 40 patients (35 females, 5 males) with an average age of 74.2 years. Twelve patients had a history of osteoporosis/osteopenia. By AO classification we repaired 14 class A, 17 class B, and 9 class C fractures. Average tourniquet time was 83 minutes and all but 6 patients underwent surgery without general anesthesia. At final radiographic measurements (average = 85 days post-operatively), average ulnar variance measures -0.39mm, average radial inclination measures 21.05 degrees and average volar tilt measures 7.58 degrees. On discharge, 27 patients had wrist range of motion data consistent with a functional wrist. Three patients had limitations in the flexion/extension plane, 6 patients with radial-ulnar deviation, and 4 patients had “stiff” wrists with limitations in both planes. Three patients developed complications during their care (two median nerve compressions, one non-fatal pulmonary embolism). To date, no patients have had complications of non-union or have required hardware removal.
Conclusion: Distal radius fractures in the elderly may successfully be treated with a volar bearing plate. Some useful strategies include supraperiosteal dissection of the radius from the pronator quadratus minimizing disruption of comminuted fragments, use of a longer plate for stronger proximal fixation in patients with osteoporotic/osteopenic bone, and avoidance of general anesthesia by means of regional block. This methodology allows for a safe procedure facilitating the early return of hand and wrist function - freeing the elbow and rapidly mobilizing the wrist.
Back to 2017 Scientific Program ePosters
|
