How Do We Treat the Super-Elderly with Distal Radius Fractures and What is the Outcome? A Register Study in 239 Patients of 80 years or older
Linnea Sara Arvidsson, MD; Ellen Lööf, Bachelor of Medicine; Antonio Abramo, PhD; Magnus Tägil, PhD
Lund University, Lund, Sweden
With a rapidly ageing population, the number of wrist fractures will rise dramatically in the super elderly group. Basic knowledge of outcome after fracture in this heterogenic group is absent. Our aim was to use our prospective distal radius fracture register to study the super-elderly patients with distal radius fractures. We hypothesized that the health status of the patient, rather than the chronological age, would correlate with the subjective outcome in super-elderly patients.
Material and Methods
In the XXX Distal Radius Fracture Register, all adult patients with a distal radius fracture are registered prospectively since 2003. All patients are sent a subjective outcome questionnaire (quick-DASH) after 3 and 12 months. In this study 239 patients aged 80 years or more, with a fracture between 2010 and 2012, were included. The medical records were reviewed the year before and after fracture regarding ambulatory status, type of living (independent, assisted living or nursery home), polypharmacy and comorbidity according to the Charlson index. Correlation to subjective outcome and mortality, and a binary logistic regression analysis was made.
The median age was 86 years. 143/239 (69%) of the patients returned a complete DASH-questionnaire at 12 months. 11% had been operated, of which 24/126 patients were between 80-86 years but only 1/99 > 86 years. The median DASH was 27, and one third had a DASH exceeding 35, considered as inferior outcome. Surgically treated patients had a higher risk of a DASH >35 (p=0.04). Comorbidity according to Charlson index, walking aid, polypharmacy and assisted living, did not influence the DASH-score after 12 months. The patient’s age (p<0.01) and independency (own housing, assisted living or nursery home) (p<0.01) correlated to the fracture being surgically treated or not. Mean survival time for the whole patient-group was 5.6 years, comparable to the general life expectancy of healthy patients of the same age in Sweden in 2011. The best predictor for survival was the degree of home independency (p<0.01)
- In contrast to our hypothesis, health status of the super-elderly patient, measured as comorbidity, did not appear to affect the subjective outcome or mortality after a distal radius fracture.
- Life expectancy is not influenced by a distal radius fracture among the super-elderly.
- The level of independency was the best predictor of life expectancy. This could be taken into account in future guidelines.
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